QLE with Medicare and FEHB

[jimandthom]

this is a timing question regarding a QLE (turning 65) applying for Medicare and converting to a different policy through the FEHB as our "medigap".

Prices listed below are for 2019 and both policies state that there is no deductible, copays or coinsurance for medicare assignment , covered in network treatments if we have Part B.

Rural Carriers(admin by Aetna) is our present FEHB policy where we will pay $338 per month for a $700 self plus one deductible and I believe a $4500 OOP for in network. Great policy covers most anything including chiro and a small amount for dental and vision.

We are looking at changing to Aetna Direct with a $7000k deductible and no chiro, or a small dental/vision benefit. Its price is $305 per month but includes an $1800 reimbursement account that can be carried forward up to $10K for self plus one coverage. The deductible is only an issue for the months before we each turn 65,

Medicare has a 7 month window to enroll. Office of Personal Management states that a QLE (turning 65) allows us to change our policy but we must apply to change starting 30 days before the QLE.

Spouses birthdate in March 12 and mine is May 3. We have to start changing spouses insurance by Feb 12 and will be effective on the first payday following OPM/FEHB completing the request.

With open season upon us, I don't want to sign up for Direct due to the high deductible in case something were to happen but I foresee the potential for issues for having both of us turning 65 so closely together but not within the same 30 day start time that OPM has for changing to a diferant policy at 65.

It seems to me that if my spouse changes policies for March 12 he would be "self only" on Aetna Direct for a couple of months and I would be "self only" from March to May on the Rural Carriers policy. Seems like a perfect timing storm to cause problem.

My choices seem to be
1--call OPM next week for clarification on the timing and then act
2--stick with Rural Carriers until open season f0r 2020
3--take a chance with the higher deductible Aetna Direct for 2019.
4--stick with Rural Carries until the QLE timing occurs and make the change to Aetna Direct and hope everything works out.

I will say that OPM has been very efficient and accurate before for us. Anybody have similar issues or am I making more of this than needed?

 

[donheff]

You do have another option than changing to a high deductible plan. Stick with your current plan which appears to work well and skip Part B saving $3200 each year or more if your income pushes Part B up. About 30% of Feds go that route (I among them). The downside is that if you decide that you want Part B later you will pay a substantial penalty.

 

[RAE]

You do have another option than changing to a high deductible plan. Stick with your current plan which appears to work well and skip Part B saving $3200 each year or more if your income pushes Part B up. About 30% of Feds go that route (I among them). The downside is that if you decide that you want Part B later you will pay a substantial penalty.

Yeah, I am a retired Fed approaching 65 also, and at this point I do not plan to add Medicare Part B either. Everyone's situation is unique, but I can't see paying the extra $$ when our current FEHB policy (BCBS) has most things covered pretty well.

 

[jimandthom]

donheff and RAE---thanks

Have kicked around the thought of not going with Part B and sticking with Rural Carriers for all.

We have a mindset that has generally bought the additional coverages--- LTC and dental/vision through the feds. We also have the extra million in liability umbrella tagging with our homeowners and auto.

Hard to let go of old habits but yep--not doing B is an additional option.

 

[DFA]

Great questions, it made me think, DW and I have full coverage though the VA with prescriptions covered too, Tricare (TCFL@65) (covers co-pay), and FEHB (BCBS +1) with Vison/Dental.

Do we need to sign up for Medicare and pay the premiums since all of our medical is covered. I understand if we sign up later we would pay a penalty, but if we never sign up would they come after us?

 

[donheff]

donheff and RAE---thanks

Have kicked around the thought of not going with Part B and sticking with Rural Carriers for all.

We have a mindset that has generally bought the additional coverages--- LTC and dental/vision through the feds. We also have the extra million in liability umbrella tagging with our homeowners and auto.

Hard to let go of old habits but yep--not doing B is an additional option.

I too have LTC and a big umbrella. I just calculated that I was unlikely to have enough Medial expenses under FEHB to make Part B worthwhile. The only real advantage I can see is that the insurers (at least BC/BS and GEHA) will pay all out of network costs as long as the physicians take Medicare. But their networks are wide enough in DC that I still don't see an advantage.

Great questions, it made me think, DW and I have full coverage though the VA with prescriptions covered too, Tricare (TCFL@65) (covers co-pay), and FEHB (BCBS +1) with Vison/Dental.

Do we need to sign up for Medicare and pay the premiums since all of our medical is covered. I understand if we sign up later we would pay a penalty, but if we never sign up would they come after us?

There is no "come after" to worry about. It is perfectly proper to skip Part B and rely on the physician benefits under FEHB. The carriers save a fortune if you take Part B which is why they offer no deductible, no co-pays, and out of network coverage if you elect to take Part B.