Health Insurance?
 

I am shopping for health insurance for next year. We currently have BCBS basic through the postal service. We have been happy with it, but the premiums are increasing for next year.
We were thinking of getting a Medicare advantage plan. I was wondering if anyone has these and are they happy with them.

These have been discussed as nauseum and there are plenty of detractors as there are happy ones. Go talk to the people at SHINE and ignore most of what you hear here.

We also have BCBS with the federal government and we have basic Medicare and it works very well for us.

Of course this insurance is not accepted by the Villages Healthcare System, but there are MANY doctors in The Villages and in our neighboring communities that love our insurance.

For example Villages Dermatology accepts our insurance and we have never had to pay anything. When they sent me to the Moffitt Cancer Center in Tampa, we received excellent care and did not have to pay anything.

For my six-month check-ups, I see Dr. Justin Morgan in Leesburg and he is associated with the Orlando Health Care system. I never have to pay anything.

Like I said, BCBS and Medicare works very well for us.

It is excellent insurance, my wife has it and she will never give it up. Plus, with basic option you get $800 back each year. I’d like to have her go to Self +1 but to do that is very expensive.

OP, if you are over 65 I would suggest contacting SHINE and discussing with them to get UNBIASED information, as noted previously there are probably hundred's of comments and opinions. Also, remember if you go to an ADVANTAGE plan you have a limited time to go back to original Medicare, I believe this is less than 1 year.

I hope you are not thinking of dropping your postal insurance.

I have BCBS Standard with the Federal Government, but I do not have Medicare, except for the free Part A. I have saved thousands of dollars by not paying the Medicare premiums. The BCBS has a $6,000 annual catastrophic limit, which provides all the protection I need. Yes, you are not paying money out-of-pocket, but you are paying high Medicare premiums, especially if you are affected by IRMA. Do the math and compare the Medicare premiums with the $6,000 catastrophic Blue Cross limit to see if you really need Medicare.

Don’t drop it, suspend it. Once you drop it, it is gone.

I have freedom for a supplement. Get most of Medicare part b back, no copay for primary, $175 per day for first 4 days in hospitals, then nothing up to 90 days, and $500 Mastercard for any athletic activity which includes any golf course in the USA. No monthly premium.

Before you even consider an Advantage Plan, understand that uf it isn't a federal plan listed with FEHB and/or your post office system, yoy MUST do the correct paperwork to suspend your federal health coverage. If you don't, you will not be able to het back into the FEHB system.

If you select GEHA standard plan you can then switch to the GEHA Federal Advantage plan which looks gr8 -- I plan on doing that this year.

For 2 years I had a FEHB Aetna plan and then moved into their Federal Aetna Advantage plan. The plan was good but local doctors here have begun to refuse Aetna Plans.

Just because you save a little money, getting an advantage plan puts you at risk. This has been brought up many times before but here are some snippets from prior posts about this issue.
How many hospitals aren’t accepting advantage plans? Dozens and the list is growing. This has been in papers and websites for months now.
The biggest risk is that you have a 60-70% chance they (advantage plan provider) will deny medical service for you. Why do advantage plans get to decide what medical procedures will be performed when Medicare doesn’t require any such approval?
Medicare with a supplement plan is the gold standard

talk to SHINE
 

I had the same question. We went to talk to SHINE, and then went to the BCBS workshop they held in Wildwood a couple of weeks ago. After comparing options, we decided that sticking with the FEP BCBS Basic plan is the best option for us. SHINE couldn't find a cheaper option, and the $800 refund for each of us for the Medicare part B plan is only available in the BCBS Basic plan. We are starting to accumulate a list of expensive prescriptions, and the BCBS CVS Caremark mail delivery service is the cheapest Rx service we can find. There are plenty of medical providers that are in the Basic Plan PPO system. We've never had a problem finding a provider around this area, or anywhere else.

I believe that you can go back at any time - depending on your health. If you have developed some severe health problems such as kidney or cancer they will probably refuse you.

However, if you have to go back to Medicare and you have health problems, I think you can get around the denial problem by moving to New York, Maine, Massachusetts, or Connecticut. I don’t think think they allow the medigap companies to refuse you.

Be careful of the other plans. Check their rate of declining requested services. There is a reason they are less expensive

Stick with BC/BS and Medicare. That’s what I have. I didn’t even get charged a co-pay, even for major surgeries.

Insurance
 

Pay the premium and be glad you have the best insurance money can buy. I second everything another Fed said about BC/BS. You can go to almost every doc/hospital in the country - except The Villages Health. BC/BS also has a pharmacy benefit, so you don't need Part D. That in itself is a huge benefit. They pay for many drugs that Medicare doesn't cover.

My wife and I are in the exact same boat. Been going to Dr. Morgan since we moved here, and he is great. With our FEP Blue as a supplement, we have never had to pay out of pocket for anything. While we are generally healthy, we have had some rather costly procedures over the years, none of which cost us a dime. I also go to Alliant Dermatology twice a year, and it is not unusual to have minor surgical procedures there...again at no cost to me. Very glad we kept the FEP Blue after retirement.

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I didn’t think BCBS would pay once you were eligible for Medicare part B. My brother didn’t sign up for part B and then he submitted a hospital claim and they wouldn’t pay it because he was eligible for Medicare. He missed the window to sign up and now he pays a much higher premium for Medicare part B as a penalty.

I am a few years away from having to think about this but I am wondering about SHINE. Several of you have mentioned to go talk to them. Where are they located and who are they? Thanks for the info.

Not true for retired Federal employees. I have never had Medicare Part B. It is entirely optional. The only health insurance I have is the retired Federal employee BCBS Standard plan. Since I fall under IRMA, my Medicare premiums would be very high and a waste of money. With the BCBS insurance, the catastrophic limit of $6,000 is a great benefit. If I ever need to pay high medical bills, my maximum out-of-pocket annual expense, including hospital charges, surgery, doctor visits, prescription drugs, copays, and other fees will never exceed $6,000. To me, that is the only health insurance I need.

1st of all Postal FEP is no longer 2025, Postal is switching from FEP to PSHB, self insuring. Self only basic enrollment code is going from 111 to 35A. FEP basic cost for 2025 $245.18 verses $247.26 for new PSHB. Like others have said a lot for places are dropping advantage plans and more doing so because of late payments and denial of procedures. Advantage plans seem to be ok if you are healthy but if you need medical care than they appear to not be that great. Check out SHINE like others have said.

Be VERY careful about giving up your BC/BS. Once you give it up you can't elect to get it back- at least that's how my Fed. VA works.

I was in the same boat since I retired in 2012. It was drilled into be since EOD 7/9/78 do not ever give up FHEB.

It seems a lot of people here knew--you can SUSPEND (NOT cancel) your FHEB with an OPM RI 79-9. I only learned I could suspend my FHEB last fall. I suspended my benefits 1/1/2025.

It was a lot cheaper for us to suspend BCBS Standard go with a Medicare Advantage Plan. BCBS and Medicare (IRMAA) was costing us over $1,100 per month. AND--we still paid over $1,100 per year for Caremark.

The hardest part was getting me to finally accept that I could suspend my FHEB so long as I am enrolled in a Medicare Advantage Plan. I spoke to persons at OPM and copied the websites. The final letter told me how (and when) I could get back into FHEB.

https://www.opm.gov/forms/pdf_fill/ri79-9.pdf

I wish those states wouldn’t have that policy, which differs from just about every other state. That policy creates unnecessary risk for the Medigap providers, which is passed along in the form of higher premiums. It effectively penalizes those who choose a Medigap plan from the get go and don’t try to game the system by selecting and Advantage plan when they are healthy and then switching to a Medigap plan (without medical underwriting) if/when they develop an expensive medical condition.

Be VERY careful. If your BCBS is the same as mine from The VA, once you drop it you can't get it back. I have Fed BCBS as well as Medicare A and B. I pay for part B every month- maybe $180(?), but BCBS Refunds $800 of that to me in cash every year. Plus- BCBS recently enrolled me in medicare Part D (drugs) for FREE. Call BCBS of Florida to determine if your current plan offers these perks- or if you can switch to one like I described. I have NEVER paid a co-pay in the 2 years since I retired- and I'm at the doctors a couple of times every month.

Medicare Advantage
 

Assuming you are old enough for Medicare - I would say you must get a Medicare Advantage Plan as they cover all the stuff that Medicare covers AND many other things such as dental, vision, and hearing that Medicare does not cover or they cover better. There are several tools that can help you get this comparison.
In TV, be sure to pick a plan that is accepted - I know that United Healthcare and BCBS Advantage plans are widely accepted. Additionally, there are frequent seminars given to help people with the decision - The Villages Health is one that provides frequent ones and The Villages Insurance is another resource.
When I turned 65, I was confused by all the options for Medicare Advantage. I am an AARP member and would like to believe they have the best interests of us seniors. They recommended United Health care so that is what I went with. UHC has a "Village Plan" that has really worked well for my wife and I this past 6+ years. And there is NO PREMIUM (and that's true for most Medicare Advantage Plans). UHC is also widely accepted across the country which is helpful if you travel and especially if you are not a full time resident here - i.e. they have preferred providers in most states.
Be aware that once you pick an Advantage plan, you can easily change once a year in November/December timeframe to another plan. Also, you and spouse do not have to be on the same plan. It's not like the family plans that we were all used to under private insurance. Each person "stands alone" as far as deductibles and co-pays goes.
There are Medicare supplement plans too but most, if not all, of these have premiums. I mention this type of plan so you don't leave this out of your research. I think these plans are a better option if a person has health issues or chronic conditions. But again, one person can be on a supplement plan and the other on an advantage plan.
Research is key and there are resources to help. I would stay away from the ads on television that offer to help find a plan for free as they are paid based on the policies they write and may not have the best interest of the person in mind. Suggest starting with United Healthcare website to get a feel for a plan. Florida Blue is also a good one.

Do you also have a Medicare supplemental plan? if so, do the math and compare your Part B premium plus your supplemental insurance premium plus any deductibles to the Standard BC/BS catastrophic limit. The BC/BS Standard plan has an annual catastrophic limit of $6,000, which means that when you exceed $6,000 in out-of-pocket expenses, everything will be covered at 100 percent for the rest of the year. This includes hospital, medical, prescription drugs, co-pays, and deductibles. If you are paying more than $4,000 per year for Medicare premiums and deductibles, you may want to consider dropping the Medicare insurance. In my case, the Medicare premiums would exceed $6,000 per year so it is a no brainer that Medicare is a total waste of money. Even at $4,000-$6,000, you will probably save money by dropping Medicare. The reason BC/BS pays you $800 per year is because the BC/BS insurance is mostly redundant with Medicare, so they save a lot of money if you have Medicare.