Medicare: figuring out what to do...

[zl55lz]

I'm worried about the IRMAA premiums for Part B. I also have BCBS, which is probably the most expensive, but not sure I want to go to BC Basic because it limits providers altho it does give some $ back for taking Part B.

I'll check out checkbook.org, thanks! I've just used BCBS for years - haven't checked out the other plans in awhile so if you have recommendations....? One of the articles I read did say if you have GEHA, you should really look at getting Part B! But I don't know about the other plans. I do like that BCBS works internationally, and with Standard I can choose my own docs.

There are definitely a lot of different things to consider when pairing a FEHB plan with Medicare Part B, such as which IRMAA tier is one in, and for how long? What is most important to oneself, the premiums, the coverage, Prescription needs, Overseas coverage, Skilled Nursing Facility coverage, is it for Self Only or Self+One, how much is the catastrophic out of pocket max yearly, etc. I don't know how various FEHB plans work for overseas coverage, but I do know that I see plans which could be much cheaper than Standard and maybe as good as or more coverage when paired with Part B. Also, some plans are so much cheaper than Standard that it could offset some or all of the additional IRMAA cost? We were on Standard for decades, but now as an annuitant we are on Aetna Direct at about half the premium and have Parts A and B too. Our Part B premiums and the FEHB premium combined are literally cheaper than having Standard only (Self+One as of 2024) and gives us great coverage and a medical reimbursement fund of $1800 per year, and outstanding Part D option Rx coverage with a $2000/yr out of pocket Rx cap at this time.

 

[KimmK451]

Thank you! I am looking at changing insurance so this is very helpful. I'll have to spend some more time researching the various plans (I have a little time before it's urgent), which ones my doctors accept, etc but I do appreciate the advice!

 

[zl55lz]

I'm worried about the IRMAA premiums for Part B. I also have BCBS, which is probably the most expensive, but not sure I want to go to BC Basic because it limits providers altho it does give some $ back for taking Part B.

I'll check out checkbook.org, thanks! I've just used BCBS for years - haven't checked out the other plans in awhile so if you have recommendations....? One of the articles I read did say if you have GEHA, you should really look at getting Part B! But I don't know about the other plans. I do like that BCBS works internationally, and with Standard I can choose my own docs.

Recommendations are difficult because each person has their own needs and what is most important to them. I do know from what I have read over the years that the FEHB plans which seem to be mentioned the most often are BCBS Std, BCBS Basic, NALC High, MHBP Std, GEHA Std, and Aetna Direct. There could be many others depending on where one lives, etc. NALC and MHBP can be enrolled in by any federal employee/annuitant at this time, not just Postal employees/Retirees. Of course, any plan can change or drop out in the future. Some plans could work better than others with Medicare or others maybe better if one did not have Medicare in my opinion.

 

[jastew]

About to go on Medicare myself. I currently have retired FEHB (BCBS) but thinking of switching to Tricare so I get TFL and the Mrs (61) can go on Tricare Select. Thoughts? Any red flags?

Clarification - I'll do Medicare A & B with Tricare. The Mrs will be on Tricare Select.

 

[zl55lz]

About to go on Medicare myself. I currently have retired FEHB (BCBS) but thinking of switching to Tricare so I get TFL and the Mrs (61) can go on Tricare Select. Thoughts? Any red flags?

Clarification - I'll do Medicare A & B with Tricare. The Mrs will be on Tricare Select.

Have you compared Tricare vs FEHB in all facets, such as premium, Rx, providers, out of pocket max, etc? If a traveler, how does overseas coverage factor in with both plans?

Also, if a person cancels FEHB, they can never get back on it per current regulations (there is an exception).

See OPM form RI 79-9 for info on cancellation/suspension. I would also speak with OPM.

I think it would be a good idea to speak with both OPM and VA to see what happens in various scenarios and if you are allowed to suspend (not CANCEL) one or the other and still be able to get back on later. Keep documentation of info.

 

[jastew]

Have you compared Tricare vs FEHB in all facets, such as premium, Rx, providers, out of pocket max, etc? If a traveler, how does overseas coverage factor in with both plans?

Also, if a person cancels FEHB, they can never get back on it per current regulations (there is an exception).

See OPM form RI 79-9 for info on cancellation/suspension. I would also speak with OPM.

I think it would be a good idea to speak with both OPM and VA to see what happens in various scenarios and if you are allowed to suspend (not CANCEL) one or the other and still be able to get back on later. Keep documentation of info.

I definitely plan to suspend FEHB vice cancel. Moving to Tricare is one of the circumstances that allows that.

Annual premium for Tricare is in the hundreds of $ as opposed to $6000+ for FEHB. Out of pocket costs are not radically different.

 

[motley]

About to go on Medicare myself. I currently have retired FEHB (BCBS) but thinking of switching to Tricare so I get TFL and the Mrs (61) can go on Tricare Select. Thoughts? Any red flags?

Clarification - I'll do Medicare A & B with Tricare. The Mrs will be on Tricare Select.

I can't speak to FEHB, but re Tricare, IMHO for you Tricare Prime is better, FWIW.

 

[jastew]

Possibly but the Mrs is pretty fond of her doctros

I can't speak to FEHB, but re Tricare, IMHO for you Tricare Prime is better, FWIW.

Probably, but the Mrs is pretty fond of her doctor and doesn't want to muck with a PCM.

 

[AudiDudi]

If you have a separate Part D plan, be sure you check every year if their coverages or tier levels for drugs have changed. DW had the same plan for about 5 yrs when I noticed they had dropped coverage on one of her drugs. Had she not switched to a new provider, the cost would have been over $8k more out of pocket!

 

[motley]

Possibly but the Mrs is pretty fond of her doctros

Probably, but the Mrs is pretty fond of her doctor and doesn't want to muck with a PCM.

Got ya...I live outside of the 30 mins zone, so I have some choices and like the better IMO overall cost options of Prime (costs more up front, but easily made up with no deductible, lower co-pay/etc costs).

 

[Koolau]

If you have a separate Part D plan, be sure you check every year if their coverages or tier levels for drugs have changed. DW had the same plan for about 5 yrs when I noticed they had dropped coverage on one of her drugs. Had she not switched to a new provider, the cost would have been over $8k more out of pocket!

Isn't it unusual for a drug plan to simply "drop" a drug for coverage unless there is a substitute? I went through this with Jardiance vs Farxiga. Both are SGLT2 inhibitors and I can't tell the difference (effect and tolerance.) One is covered and the other is not now. I had to have my doctor change my script. Cost is about the same or a bit lower IIRC.

 

[Koolau]

Isn't it unusual for a drug plan to simply "drop" a drug for coverage unless there is a substitute? I went through this with Jardiance vs Farxiga. Both are SGLT2 inhibitors and I can't tell the difference (effect and tolerance.) One is covered and the other is not now. I had to have my doctor change my script. Cost is about the same or a bit lower IIRC.

Oh, and my plan always sends me a formulary list in the fall so I can see what is covered and how it's covered.

 

[wrigley]

We have Medicare Parts A & B. We also have Tricare for Life (TFL). The way it has always worked for us is Medicare is our Primary insurance, TFL is our secondary insurance. Claims always go to Medicare first, then Medicare forwards claims to TFL. Each insurer pays there part - our deductibles are very low. There is no premium for TFL. TFL is also our prescription insurance - we can go to almost any pharmacy or use TFL mail order pharmacy. In the 8 years we have been on these plans we have never had any issues - 9 times out of 10 we never even pay a co-pay. YMMV...

There is no premium for TFL, but you still pay the Tricare prime premium, correct?

Mike

 

[AudiDudi]

Isn't it unusual for a drug plan to simply "drop" a drug for coverage unless there is a substitute? I went through this with Jardiance vs Farxiga. Both are SGLT2 inhibitors and I can't tell the difference (effect and tolerance.) One is covered and the other is not now. I had to have my doctor change my script. Cost is about the same or a bit lower IIRC.

The drug was Xarelto. I guess Eloquis does roughly the same thing. Humana was the one that dropped it. (at leasrt for the plan she was on) DW just changed providers and maintained coverage. The point is, one needs to check every year to avoid a big surprise.

 

[motley]

There is no premium for TFL, but you still pay the Tricare prime premium, correct?

Mike

No, that's something entirely different. TFL is when you have Part A and B; it's effectively like Medigap (but free). Prime is for people not getting Medicare yet.

 

[Koolau]

The drug was Xarelto. I guess Eloquis does roughly the same thing. Humana was the one that dropped it. (at leasrt for the plan she was on) DW just changed providers and maintained coverage. The point is, one needs to check every year to avoid a big surprise.

Insurance companies negotiate with drug makers for price. (I know this to be true.) Somewhat speculating: Two drugs like Eliquis and Xarelto which have the same basic profile are likely played off against each other (Hey, we're gonna pick one or the other - based on what price you'll promise us.) SO no big surprise they only cover one of the drugs - the one they got the best price on.

Now, to an extent, I'm guessing on this, but I'm reasonably sure it w*rks something like this for drugs which are this similar. The single advantage of Xaraleto over Eliquis is that Eliquis typically is taken twice per day instead of once. MY guess is that Eliquis knew it was at a disadvantage (for that reason) and caved to the price demands of the insurance co. Thus they don't cover Xarelto but do cover Eliquis.

By the way DW had to switch from Xarelto. (I had to switch from Jardiance to Farxiga) - all due to price to the insurance company I would speculate.

I've just told you way more than I know about this subject, so YMMV.

 

[motley]

Insurance companies negotiate with drug makers for price.

Same for many (most?) other things medical like dr visits, covering operations etc. And those doctors and hospitals have no problem swimming around you like sharks to blood if they know you don't have insurance. This should be more regulated

 

[wrigley]

No, that's something entirely different. TFL is when you have Part A and B; it's effectively like Medigap (but free). Prime is for people not getting Medicare yet.

No, that's something entirely different. TFL is when you have Part A and B; it's effectively like Medigap (but free). Prime is for people not getting Medicare yet.

Thanks. I was under the impression you still paid the Tricare Prime premiums even after turning 65 and paying for Medicare Part B. I guess I was mistaken.

Mike

 

[motley]

No, because you can't be in Tricare Prime (or Select) when you turn 65 (or otherwise are eligible for Medicare). They're each distinct different plans.

 

[AudiDudi]

Insurance companies negotiate with drug makers for price. (I know this to be true.) Somewhat speculating: Two drugs like Eliquis and Xarelto which have the same basic profile are likely played off against each other (Hey, we're gonna pick one or the other - based on what price you'll promise us.) SO no big surprise they only cover one of the drugs - the one they got the best price on.

Now, to an extent, I'm guessing on this, but I'm reasonably sure it w*rks something like this for drugs which are this similar. The single advantage of Xaraleto over Eliquis is that Eliquis typically is taken twice per day instead of once. MY guess is that Eliquis knew it was at a disadvantage (for that reason) and caved to the price demands of the insurance co. Thus they don't cover Xarelto but do cover Eliquis.

By the way DW had to switch from Xarelto. (I had to switch from Jardiance to Farxiga) - all due to price to the insurance company I would speculate.

I've just told you way more than I know about this subject, so YMMV.

It was easy to switch providers to one that covered the Xarelto and the premiums were about 50% less than Humana wanted. I agree the ins co's do negotiate prices. I'd also bet that if a large number of people are using a spendy drug and are subscribed to the plan, they will drop the drug in that plan.

I generally wait until early November to compare plans as one I had chosen to go with a few yrs ago (but not signed up) changed their pricing around Nov 1st. Almost got me!

 

[Koolau]

Same for many (most?) other things medical like dr visits, covering operations etc. And those doctors and hospitals have no problem swimming around you like sharks to blood if they know you don't have insurance. This should be more regulated

I don't know what this means.

These days, very few people do not have insurance - unless they choose not to. If they have no money, other options - essentially "free" gummint insurance (Medicade) is available. That and with ACA, coverage IS available to almost everyone. Us "rich folks" are the one who get taken advantage of.

 

[motley]

It varies by state. Some may make a meager income yet still don't qualify for Medicaid (and don't work somewhere that provides coverage). I don't think it's "almost everyone," but admit I don't know the specifics.

 

[maxq]

I had a similar choice a few years ago -- Tricare's USFHP (limited geographic areas and much like Medicare Advantage plans with a network, referrals, etc) or T4L. I went with T4L, as I can pretty much choose any doc or medical practice or hospital that accepts Medicare. No T4Lpremium, no deductible, no referrals from PCP required. You just pay your A and B premiums, along with IRMAA as required. It serves as creditable Part D coverage and Rx co-pays are very reasonable (most are $12 or $14 for 90 days via mail order; free if you can get through a local military pharmacy or VA if enrolled and eligible). No dental or eyeglass coverage though. T4L does have an overseas benefit and provides some coverage that traditional Medicare does not. I had surgery earlier this year and sure can't complain about the cost to me: No pre-approvals required; I chose my surgeon and hospital. Hospital and docs charged $140K. Medicare approved $115K. Medicare paid $11K and T4L paid $2.6K. I guess the rest just gets written off. My only costs were garage parking at the hospital and 3 $12 prescriptions. Medicare and T4L claim paperwork was all done by the hospital or docs and totally transparent to me.

P.S. For the person who thinks pretty much everyone has insurance, here in Texas close to 20% are uninsured. This equates to something like 5 million folks. Lots of politics involved.....

 

[KarenF]

Due to my military allowing me Tricare, I think my plan is clear: Medicare A and B plus Tricare should pretty much cover me, as that basically acts as my "Medigap." But I still found it kind of a maze and took more than a little reading and research, and realize others may be debating which way to go and thought it might be worth having a thread about it...

I have a friend in the same situation. He did get a $0 premium Advantage Plan and if that does not cover, the Tricare for Life will. Just a thought.

 

[motley]

Yeah I think we'd all be surprised if we found out how many people don't have it.