Federal Retired Employee - Medicare - which plan
 

My husband is retired on disability from his job as a federal employee. He is under age 65 and now is eligible for Medicare next month.

Looking for suggestions/recommendations on which BC/BS plan (standard or basic) works best with Medicare Part B. I realize we can't change plans now, but gathering up facts/info for the upcoming open enrollment season.

thank you

We are happy with BC/BS standard option. With Medicare A & B there are no co-pays or deductables in most cases. Rx plan is also good. If provider does not accept Medicare assignments, there may be out of pocket expenses.

Go to SHINE SHINE - Home to get an UNBIASED review of the various options. NOTE: health care in TV is somewhat confusing, if you want Villages Health Care, you MUST use one of the UHC ADVANTAGE plans, and you potentially give up the ability to switch back to Medicare supplemental plans (B). My wife and I have been through this twice, she tried the VHS advantage plan, did not work for her waits for specialist were way too long, but PC was great, cost was great, but she needs several specialists, NOT great.
Do your homework on this, especially if you are looking at an Advantage plan.
Send me a PM with your phone number if you would like to discuss further.
Also, if you search this site using SHINE as the search work, your should get several results with LOTS of discussions.
Hope this helps.

We have the higher option Federal BC BS (more expensive plan). It is great insurance. We are not members of the Villages Health Care and there are plenty of doctors and specialists to see here. We are not limited at all and can go pretty much everywhere. My husband has been on Medicare and Federal BC/BS for 5 years and we have paid nothing except the premiums.

I have the FEP Blue Cross standard plan only. I do not have Medicare Part B because the premium would be about $260 per month. In my opinion, it is not worth paying more than $3,000 per year in Medicare premiums when the Blue Cross insurance has a castastropic limit of only $5,000 per year. So, after out of pocket expenses exceed $5,000, all other covered expenses are paid at 100 percent. Why do you need to spend over $3,000 in Medicare premiums when you already have adequate coverage with the Blue Cross plan? If, based on income, your Medicare premium is over $3,000, do the math and you will save money by not buying Medicare Part B. You will still get Medicare Part A, which has a zero premium.

We have standard BCBS and Medicare Part B. We do not have Part D. We get our prescriptions thru BCBS. SSHINE told me this it the “Cadillac” of insurance plans.

I have BC/BS Federal High option (the most expensive). My husband was a federal employee for over 30 years. I am 64 years old. Over the last five years I have had a lot of out of pocket expenses which mostly consist of copays for x-rays, MRI's, CAT scans, blood work, co-pays for pain management procedures. Over the last five years each year our out of pocket was over $10,000 for these type of expenses. The co-pays on these types of tests are 15% of the allowed amount. I am counting the days when I get my medicare this fall so that these expenses go away. I couldn't imagine not signing up for Medicare when it becomes available to me. This article has a lot of information. One that sticks out is the difference between the allowed amount and billed amount. I think that is what has cost me so much.

FEHB and Catastrophic Protection

I'm confused. If you have the individual Blue Cross plan, the catastrophic limit for out of pocket expenses is $5,000 per year, so you would never have any expenses that exceed that amount. If you have the family plan, then the catastrophic limit goes up to $10,000, but you could purchase 2 individual plans and limit the catastrophic to $5,000 each. Before signing up for Medicare Part B, it is worth the time to do the math and compare the cost for the Medicare premiums to the potential benefits you may receive during the year. In my case, the Medicare premiums would be about $3,300. So, the potential benefit of having Medicare is a maximum of $1,700, the difference between the Blue Cross catastrophic limit and the Medicare premium. However, this potential benefit is usually lowered by the out of pocket costs for drugs, which are part of Blue Cross, but not covered by Medicare. And, most people don't spend the catastrophic limit every year. Some people like that they have no copays with Medicare and Blue Cross, but they forget that it is costing them the Medicare premium that is due every month.

Yes we have the family plan for the two of us. If you check the policy BC/BS Federal requires a 15% co-pay for tests like MRI, Xray, bloodwork, CAT Scan, out patient procedures (15% of the allowed amount), etc. These days many, many surgeries are outpatient that used to be in-patient and they only pay the allowed amount on these and the doctors most times will send you a bill for the rest which includes the anesthesia, tests and doctor's bills. Those have been putting me in the poor house for the last five years. Recently I spent 8 hours in the emergency room for food poisoning. My out of pocket for that was $777. It was the difference between the hospital bill and what the insurance paid. When I get medicare to go with my BC/BS Federal I am praying all that goes away. Not sure where these fall in the catastropic part because they don't really say in that article. I have to assume if they were considered catastrophic BC/BS would have stopped charging me for them long ago. When I did my taxes this year I had over $20,000 in medical. Some of that was premiums but the rest was not it was what I mentioned above as well as doctor co-pays. Might be worth a call to BC/BS.

If you use the Blue Cross preferred providers for medical care, the provider cannot charge you more than the amount allowed by Blue Cross. The only way a doctor can charge you more than the allowed amount is if they are not a preferred provider, but almost all bona fide providers in the area are preferred providers. I have never had a problem finding a good preferred provider for Blue Cross. And, when your out of pocket costs, such as copays and coinsurance, exceed the catastrophic annual limit, Blue Cross will cover everything else at 100 percent. That is the way the insurance plan works. In general, Medicare is not going to cover things that Blue Cross doesn't. It will only reduce your copays and coinsurance payments, but you need to weigh that benefit against the cost of the Medicare premiums.

When you are in a situation where you are in a hospital for a surgery or procedure there are times when you will be treated by an anesthesiologist or doctor in the emergency room or in the outpatient center whereas the hospital or facility is in your plan but the doctors are out of network doctors. They do not tell you this when you are being treated. The way you find out is when you get the bill. You can't stop each doctor who is treating you and say "are you in my plan?". There are so many people who are involved in your care that it would be impossible and just would not work. My husband has our insurance BC/BS federal and Medicare for the last five years. He has had many kinds of procedures and has had to pay $0 for anything. This includes tests and labs. I am hoping and praying that this will be in my future. When you sign up for Medicare IT becomes your primary and BC/BS is secondary.

Medicare Part B premiums are different for most people. My premiums are half of retiredguy123.
Jnieman - BCBS FEHP Standard and Medicare do provide little or no out of pocket costs, except for RX co-pays. You should do very well with FEHP and Medicare B.

In case you did not know, the FEHP Basic Plan introduced a new benefit which included a $600 reimbursement of the Medicare B premium. IMHO when combined with Medicare B there is little difference between the Standard and Basic plans.
After doing my homework, I decided to switch to the Basic Plan which has lower premiums then the Standard Plan and now pays $600 of my Medicare Part B premium. So far - so good! Please do your own comparison before switching between the Standard and Basic plans.

Taking the time to clearly understand the benefits of health care packages is time consuming and making changes can be scary. After all, insurance is protection against the unknown. I learn from the insight of other people. Good Thread!

I can follow your logic based upon Todays world, but things can change dramatically with the Federal BCBS plan.....and once your out of Medicare Part B...its extremely expensive to get back in!

If you delay the purchase of Medicare, there is a 10 percent per year penalty. But, that penalty only applies to the basic part of the premium, not to the increased premium that is based on your income. I am willing to take my chances rather then pay, what I consider to be an unreasonable premium. I think the Medicare premium should be the same for everyone and not based on income, since you have already paid more for the program while working, and you get the same benefits as everyone else in the program.

I am very surprised that you encountered an anesthesiologist or doctor in the emergency room who were not preferred providers for the FEP Blue Cross plan. Can you provide their names, so I can avoid them? When I go into a hospital, I always verify that the hospital is a preferred provider, and that the surgeon and the anesthesiologist are also preferred providers. You absolutely have the right to ask and verify this information. But, I have found that almost all competent medical providers accept the FEP Blue Cross as preferred providers and I have not yet found a single provider so far in The Villages who are not. Even the urgent care facilities in The Villages are preferred providers.

For me most recently it was an anesthesologist at the Santa Fe Surgery Center. It also happened to me a couple of years ago at The Villages Hospital. I don't have records of their names. I would have to pull out tax records and sort through bills. The one at Villages hospital was an emergency room doctor.

When I confronted the Santa Fe Surgery center about it they took my name, contacted the doctor then called me back and said to pay the amount Blue Cross paid me and it would be settled. In some cases they will bill you just to see if you will pay it. To me that is preying on seniors. That was not the case for the emergency room visit. It cost me around $600 for that. I had read something recently that this happens across the country at hospitals and that some states are making laws that they can no longer bill you more than what the insurance pays when the doctors are out of network practicing in in-network hospitals. Not sure if Florida has joined those states as of yet.

Thanks. I agree that this is preying on seniors. But, I did call The Villages Hospital billing department and they told me that, if you have a scheduled surgery or procedure, you can tell them that you only want to be treated by in-network providers and they will comply. They also said that they do have some out-of-network doctors working in the emergency room, but that it would be extremely rare that they would charge more than the FEP Blue Cross plan because the plan is so highly popular and well recognized. But, personally, unlike some people, I am not at all hesitant about discussing insurance coverage and costs with anyone who is treating me or providing any kind of medical service.

The thing to me that is the most upsetting is that as we age we are not always capable of dealing with insurance issues such as these and know to make that phone call to challenge a bill or ask for an in-network doctor. I know that I have been taken advantage of over the years this way and it won't be happening again.

Last year my husband went to TV ER. We know this is a participating hospital. The one surgeon was not participating - we discovered later when the bill came in. All other providers and facility were participating. In the case of the non participating physician, they can "balance bill" you - the difference between their original bill and the amount they receive from the insurance company. I fought that bill for over a year.

I think it is outrageous for the hospital to allow that to happen, and for a doctor to try to rip someone off in the emergency room. It is clearly price gouging. I have never wanted to sue anyone, but this may be an exception.

Medicare Part B, FEHB, Tricare
 

Does anyone understand how the military plans play into this? I'm coming from a state where US Family Health is available so I carry Part A of Medicare but not Part B. Moving to The Villages removes this option and as I and my wife are 70 years old and 3 years past my retirement, we'd have to pay a penalty to get Part B, plus our income means we'd be in the higher $250+ a month category plus penalty. I "suspended" my FEHB when I retired so I guess our options are 1) get Medicare Part B plus Tricare for Life as a supplement, 2) use my FEHB plan without Part but with Tricare for Life as a supplement ?

You may want to consider using the Blue Cross Standard FEHB plan, with the Tricare, and Medicare Part A, which is free. Since turning 65, I have saved almost $10,000 in Medicare Part B premiums by not buying it. Most of what you get for the Medicare Part B is redundant with the Blue Cross, and you can always depend on the $5,000 per person catastrophic Blue Cross annual limit.

Ohiobuckeye
 

You know even with all the answers here, it's still pretty confusing to know which is better for each individual because everybody lives a different way & wants certian things paid for. So to really answer this question I would think it would be hard to tell someone what the best Ins. plan for them. But it still was interesting to read these comments, thanks!

I am a retired federal employee. I have found that medicare plus Blue Cross basic covers just about everything. I think that Blue Cross standard would be over paying, based on my experience.

If he has BC/BS Federal, why are you going to pay for Medicare B? What does B cover that BC Federal does not?
We have BC/BS federal Basic and like it. Although, we have had problems with Florida Blue mishandling it compared to the state we moved from.
I have Federal BC/BS basic and ONLY Medicare A. We save over $200 a month by NOT having to pay for Medicare B.

Get help and understand
 

I can tell you one thing for sure! The Medicare Advantage plans are great for people that are relatively healthy! I have some severe health issues! I chose to go with UHC Advantage when in Colorado and thought it was great, with doctors and specialists. Then had Cigna Advantage when I did two years in Texas and again no issues and recommended. However now in Florida the Advantage plans are more costly, have hidden co-pays, limited primary networks, and I even had one specialist call and cancel my appointment after it was set up! Seeing anybody quickly, primary included, has been a nightmare. I can only speak toward one Advantage plan but I went in and compared 5 different companies and found them on the front end, very similar. The one I chose is a 5 star rated so thought I knew what I was doing. So I'm not sure who all determines plans and networks and know that Medicare CMS oversees plans, but I'm not sure who to recommend because it's slim pickens out there for doctors in general once you decide. They have or are consolidated because of payment limitations. I think the state oversight and regulation has a lot to do with it also! Specialists do not want anything to do with pre-existing conditions! Then I found that these companies use retail price to determine the drug donut whole numbers! Not what insurance pays but retail and they are very different. I ran into it because of retail pricing on Advair HFA. I'm thinking original Medicare with a supplement if you can for the 20%, but remember you need part D also. The good news is you can make a change each year! The bad news is there is no guarantee you can get a supplement later on if you don't choose it on the front end. Find an independent insurance agent that wants to help you sort it out! For sure "good luck".

I am a retired federal employee. My Wife and I both have Medicare Part B along with BC/BS basic plan. In the last 5 years my wife had 2 new hip replacements and 2 new shoulder replacements. There was no out of pocket expenses, not even for all physical therapy. However, we always find a BC/BS preferred provider. My opinion is that if you go to a preferred provider of BC/BS, which there is never any problem finding, why pay the extra premium for BC/BS standard option when the basic option is so much less.

Your out of pocket expenses are the Medicare Part B premiums. If you do the math, you may find out that you would have spent less money by not having Medicare Part B at all.

make an appointment in lake sumter landing with united health care, and speak to a rep. They will be very helpful

vonbork- It is my understanding that if you have TRICARE FOR LIFE you must be enrolled in Medicare Parts A and B.

In any event, talk to one of the SHINE reps- they are awesome and are disinterested parties unlike the folks who work at the MEDICARE Stores in the Squares. If you google SHINE and Lake or Sumter county you can find times when SHINE reps are available to speak with you at Rec Centers throughout TV and in community centers/libraries in the surrounding communities. Most of them are available on a walk in basis.

Read my earlier post on this. We have BC/Standard and had plenty out of pocket by my not being old enough to get Medicare to go with it.

I am not familiar with your Federal insurance, but if your husband becomes eligible for Medicare he has a time limit to make changes to any insurances--he doesn't have to wait until the open enrollment for current beneficiaries. Go to mymedicare.gov where you can get information about some of your options. But SHINE can help you determine if you want to keep what you have vs taking TV options or Medicare with a supplement. The more information you can get to make a decision based on your needs the better. Good luck.

👍 agree

Yes, that is the Standard policy. You have to pay a deductible. The basic option, you pay a Co-payment. I do not see the benefit of having Medicare B. If you have "B" you have to pay approx. $105 each or more. Like I said, I have the Federal BC/BS basic and Medicare A only. We save over $200 per month or over $2400 per year. Maybe I am looking at it wrong, but I see no benefit of having Medicare B if you have a full BS/BC policy. Just my opinion.

I just had to go to the emergency room. I have standard BC/BS Federal and no medicare (not old enough yet). I now have a bill staring me in the face for almost $800. While there I had a Cat scan, blood work, EKG. I have to pay co-insurance on all of that. If I had medicare part B my out of pocket would have been probably zero.

Yes, it would be zero. But, you need to calculate how much your Medicare B premiums will be when you turn 65. My annual premium would be about $3,300. I would rather pay an occasional $800 bill then pay $3,300 every year even if I don't have medical bills. And, I am always protected against a major illness expense because of the Blue Cross $5,000 catastrophic limit.

I guess I need to study that $5000 catastrophic limit because I have never been able to benefit from it. Last year we had over $20,000 in medical expenses to deduct. $7000 of that was in premiums for my husband's medicare and our BC/BS, but that leaves over $13,000. I wonder if the catastropic only kicks in for a major event.

With BC/BS Basic, you do not pay deductibles, only co-pay. A $22000 knee replacement cost $150 hospital co-pay and a $150 doctor co-pay. I believe I got the doctor co-pay right. A family with the Standard policy will pay something like $10000 deductible. But, I think the whole thread was the idea of having Medicare B WITH private insurance. My opinion is that it is not needed. Medicare A pays hospital costs. Having a great private insurance like BC/BS FEDERAL, it just about covers most most of costs.

That is if you are admitted to the hospital you don't have the large co-pays. So many of the surgeries now a days are out-patient. Even larger ones like some of the back surgeries. If you are just "under observation" and stay overnight but never get admitted then you may have to pay all of those copays. It would be 15%-20% of the allowed amount. I had this happen with a gynecological surgery. I had to pay almost $2000.

The Blue Cross catastrophic limit applies to all out of pocket charges related to paid claims by Blue Cross. That includes copays, coinsurance, including prescription drug coinsurance, hospital coinsurance, and surgery and doctor charges. You can see how much has been applied to your catastrophic limit for the year by looking at any of your "explanation of benefits" statements. When you reach the catastrophic limit, all valid claims are paid at 100 percent. But, your premiums are not part of the catastrophic limit.