[klc1923]

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

[Radioman41]

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.

[villagetinker]

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.

[jnieman]

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.

[retiredguy123]

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.

[laceylady]

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.

[jnieman]

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

[retiredguy123]

Originally Posted by jnieman

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.

[jnieman]

Originally Posted by retiredguy123

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.

[retiredguy123]

Originally Posted by jnieman

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.

[jnieman]

Originally Posted by retiredguy123

If you use the Blue Cross preferred providers for medical care, the provider cannot charge you more than the amount allowed by 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.

[OCsun]

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!

[784caroline]

Originally Posted by retiredguy123

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.

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!

[retiredguy123]

Originally Posted by 784caroline

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.

[retiredguy123]

Originally Posted by jnieman

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.

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.