There has been many comments about whether retirees on FEHB should take Medicare Part B or not.
Some take it, some not. It works well for some to not take it, particularly if one is subject to IRMAA.
There is something that I think those considering their options on this should be aware of.
It is well known that if a FEHB enrollee is 65 and not on Medicare at all, they apparently cannot be charged more than the Medicare amount by regulations, unless of course the provider opted out of Medicare and one agrees with their contract to charge whatever. This is beneficial to those not having Part B. Usually less to pay, and I have seen it stated that their out of pocket is not as much as the Part B premiums per year. That might be true in most years, or not.
However, what may not be so well known is that this regulation does not apply to outpatient hospital care and non-physician based care. In those cases regular plan benefits apply. This is stated in Section 9 of most plan brochures I have seen under "When you are age 65 or over and do not have Medicare"
One of the reasons this is important is because sometimes a hospital will not "admit" a patient but rather will treat them as "observation" which apparently can be treated as outpatient, and thus falls under Part B, not Part A? My spouse had a several day hospital stay as "observation" after a surgery gone wrong which in every appearance to me was just like a regular in-patient stay. And of course, other outpatient situations happen, such as cataract surgery, etc. Charges can be costly.
Some plans have a 10% to 30% coinsurance for outpatient without Part B, this could be a significant amount out of pocket. This is why I always look at the plan % and catastrophic out of pocket limit when considering going without Part B, and one of the reasons I stay on Part B. Having said this, a plan like BCBS Basic might mitigate some of these issues because of its set copays for many or most services. However, one does need to be aware of Basic requiring in-network providers unless one of their exceptions apply.
Personally, if I were to choose to go without Part B, I would just budget for paying the full catastrophic out of pocket per year, which I routinely see being between $5000 to $8500 per person for self+one. NALC High does have at this time a comparatively low oop max of $3500/$5000 for in-network self+one.
Just something to maybe be aware of when making that decision.
Some take it, some not. It works well for some to not take it, particularly if one is subject to IRMAA.
There is something that I think those considering their options on this should be aware of.
It is well known that if a FEHB enrollee is 65 and not on Medicare at all, they apparently cannot be charged more than the Medicare amount by regulations, unless of course the provider opted out of Medicare and one agrees with their contract to charge whatever. This is beneficial to those not having Part B. Usually less to pay, and I have seen it stated that their out of pocket is not as much as the Part B premiums per year. That might be true in most years, or not.
However, what may not be so well known is that this regulation does not apply to outpatient hospital care and non-physician based care. In those cases regular plan benefits apply. This is stated in Section 9 of most plan brochures I have seen under "When you are age 65 or over and do not have Medicare"
One of the reasons this is important is because sometimes a hospital will not "admit" a patient but rather will treat them as "observation" which apparently can be treated as outpatient, and thus falls under Part B, not Part A? My spouse had a several day hospital stay as "observation" after a surgery gone wrong which in every appearance to me was just like a regular in-patient stay. And of course, other outpatient situations happen, such as cataract surgery, etc. Charges can be costly.
Some plans have a 10% to 30% coinsurance for outpatient without Part B, this could be a significant amount out of pocket. This is why I always look at the plan % and catastrophic out of pocket limit when considering going without Part B, and one of the reasons I stay on Part B. Having said this, a plan like BCBS Basic might mitigate some of these issues because of its set copays for many or most services. However, one does need to be aware of Basic requiring in-network providers unless one of their exceptions apply.
Personally, if I were to choose to go without Part B, I would just budget for paying the full catastrophic out of pocket per year, which I routinely see being between $5000 to $8500 per person for self+one. NALC High does have at this time a comparatively low oop max of $3500/$5000 for in-network self+one.
Just something to maybe be aware of when making that decision.
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