Thread: Medicare and FEHB

Originally Posted by PessOptimist

.....Is it too early to start my own retirement thread 3.93 years out?

I say go for it. I'd be interested to see how you approach your retirement at this stage.

Originally Posted by PessOptimist

I have been thinking about medical insurance after retirement/age 65 and how it is all going to work. I have two plans, TriCare Prime and BCBS Basic through FEHB.

The fact that I will be thrown out of Tricare Prime at 65 is clearly spelled out. I have to get Medicare part B in order to get Tricare for Life which is described as "Medicare wrap around insurance".

FEHB seems to say I have to enroll in Medicare Part A once I become an annuitant and highly suggests part B.

What I don't see clearly spelled out is where I get part B. From SSA? Will BCBS act as part B?

I am not sure where to post this. There is a thread titled Medicare and Social Security but it quickly devolved in to a discussion about FERS v CSRS, SS and what politicians are screwing the FEDS more. I'll start another thread.

There are some on the board who are in one, the other or both situations and over 65. How did it really work?

Is it too early to start my own retirement thread 3.93 years out?

I will be 65.58 years old when I retire with 20.5 years FED service so I will be enrolled in Medicare.

That is if the crick don't rise.

PO

PO,

Good thread !!! I, too, have been confused about how the whole Medicare thing vs FEHB shakes out ! Although Tricare isn't an issue for us, I'm not sure what to do when my Wife hits age 65 first (not a Fed, but has County-supplied/subsidized BCBS coverage)...I hit 65, 3 years later, with my FEHB... Not sure what the rules are, and what the best course of action is !

Looking forward to some concise guidance from those who have already gone down this path !

Stoplight...

of all the people i want to see retire, it's you. i say start your glide path thread now.

"if the crick don't rise". i haven't heard that one in a while.

Originally Posted by Stoplight

PO,

Good thread !!! I, too, have been confused about how the whole Medicare thing vs FEHB shakes out ! Although Tricare isn't an issue for us, I'm not sure what to do when my Wife hits age 65 first (not a Fed, but has County-supplied/subsidized BCBS coverage)...I hit 65, 3 years later, with my FEHB... Not sure what the rules are, and what the best course of action is !

Looking forward to some concise guidance from those who have already gone down this path !

Stoplight...

I'm in the same situation as you but with GEHA. My understanding is the doctor's office bills Medicare. Then I send the Medicare statement to GEHA, which is now secondary even though you pay the same each month, and they pay their part. I will get part B for my wife because see seems to love to visit the doctor about almost everything. I become 65 a couple of years later. Now for me I have the VA. So the Va becomes secondary to GEHA which is then secondary to Medicare. So the VA bills Medicare then rebills GEHA and then pays the rest taking GEHA's payment as your deductible. I haven't decided if I'll get part B yet but I'm leaning toward it because I don't have a service related disability and nobody knows what the VA might do when the goverment wants to cut funds. It might drop to only people with combat related disabilities. In 2008 they stopped letting people in my situation from entering the VA and only allowed me to stay in because I entered in 1985 because rules were different.

Not knowledgeable about the military/VA angle but for civilians, at age 65 everyone who has been paying the Medicare Part A (hospitalization) tax should sign up for it Medicare Benefits - How to Apply Online Even if You Are not Ready to Retire, it's free. Part B (Medical expenses) is optional and the premium is means tested, with significantly different premiums between singles and marrieds and quickly rising premiums in steps up the income ladder. And big penalties for delaying the decision unless remaining covered by an employer plan. If a FEHB member pays the Part B premium, the FEHB plan functions like the private sector's "supplemental insurance" plans that those retirees must buy to avoid high deductibles and high copays (and a cheaper FEHB plan may be a good choice). Fortunately for FEHB members, their plans also cover drugs, so they don't need to buy a Part D plan. It may also provide some medical reimbursement coverage overseas, which Medicare does not. So for married couples with incomes less than about $170k, the monthly premium is about $105 per month per person. From experience, it seems the medical community performs the billing functions itself, through at least the first hiccup. That is, the provider bills Medicare, and the unpaid amount rolls over (sometimes automated, sometimes provider staff) to seek coverage from the supplemental (FEHB or Part B Supplemental Plan). NB: If one is single and has an income more than about $85K you are the bill payer for the rest of humanity. This forum has been discussing this topic for years: https://federalsoup.federaldaily.com...nd-health-care

Originally Posted by Warrenlm

Not knowledgeable about the military/VA angle but for civilians, at age 65 everyone who has been paying the Medicare Part A (hospitalization) tax should sign up for it Medicare Benefits - How to Apply Online Even if You Are not Ready to Retire, it's free. Part B (Medical expenses) is optional and the premium is means tested, with significantly different premiums between singles and marrieds and quickly rising premiums in steps up the income ladder. And big penalties for delaying the decision unless remaining covered by an employer plan. If a FEHB member pays the Part B premium, the FEHB plan functions like the private sector's "supplemental insurance" plans that those retirees must buy to avoid high deductibles and high copays (and a cheaper FEHB plan may be a good choice). Fortunately for FEHB members, their plans also cover drugs, so they don't need to buy a Part D plan. It may also provide some medical reimbursement coverage overseas, which Medicare does not. So for married couples with incomes less than about $170k, the monthly premium is about $105 per month per person. From experience, it seems the medical community performs the billing functions itself, through at least the first hiccup. That is, the provider bills Medicare, and the unpaid amount rolls over (sometimes automated, sometimes provider staff) to seek coverage from the supplemental (FEHB or Part B Supplemental Plan). NB: If one is single and has an income more than about $85K you are the bill payer for the rest of humanity. This forum has been discussing this topic for years: https://federalsoup.federaldaily.com...nd-health-care

Warrenlm hit this on the nose. This is exactly how I understand it works, but I don't know how Tricare or VA benefits figure into the mix as I have no dealings with that.

My mom retired as DOD civilian many years ago. We researched it and determined it was best for her to buy Medicare Part B ( physician/ office visits, outpatient services, durable medical equipment) coverage. Medicare Part B costs her $104 per month right now. Then she kept her FEHB (with BCBS standard option) and that costs her $186 per month for single. So Medicare is first payer, then when they pay, they notify BCBS and BCBS pays what Medicare part A and part B did not pay....so FEHB acts like a supplemental insurance.

Since Medicare A and B do not cover drugs...FEHB acts as first payer and she must pay the coinsurance on drugs only. At that time there was no Medicare part D to cover prescription drugs, but when it came out we determined to not buy it because the FEHB covers the drugs. So mom continues to pay the coinsurance on drugs only.

Medicare part A (hospitalization) is free but you must sign up.

We did run into situation this year where mom had to pay $148 per day to stay in a nursing home for physical rehab. We paid 10 days costing $1,480. This happened because she kept having issues going to hospital 5 times in six months and weak enough after hospital stay to need skilled rehab to walk. Medicare par a will pay 100% for skilled rehab for only 20 days and then it drops to 80% for I believe up to 100 days after a qualifying hospital stay ( I.e. 3 days). The $148 per day is the 20% coinsurance---very steep. That got covered for 10 days by BCBS (up to day 30); but thereafter we had to pay the coinsurance. Here is the sticking point: if you go back to hospital and then back to nursing within 60 days it is all considered ONE episode...so that means you immediately get hit with the daily coinsurance if you need nursing at a skilled facility beyond 30 days. So the 4th time from hospital we brought her straight home even though she could not stand or transfer to get in a wheelchair to go potty. We got physical therapy from home health 3 times a week but we did everything else plus worked hard to do the PT and get her mobile. Took a month.

Might also consider that while healthy, Medicare HMO choices can be great but when you get seriously ill( like a sudden stroke, heart attack, car accident, etc) this will have a serious impact on ability to get good care when things go wrong. I've seen people comment about the Medicare Advantage (HMO plans) denying folks going to inpatient hospital rehab (more rigorous) than what you get at a skilled nursing (rehab) facility (I,e, a nursing home with a skilled wing). Just something to think about...I would stay away from Medicare Advantage plans unless you are very healthy..as you can only change that selection once a year just like FEHB.

So why am I so fortunate to be spending $335.70 for my monthly deduction for Medicare Part B. It's $104.90 for standard Medicare premium and $230.80 for the income related monthly adjustment based on my 2011 income tax return. So I'll just deduct these medical costs as I roll through life. My prescription drug coverage is $78.80 and that does not include the costs of the drugs.

is your mom single? i already pay for a family plan so it wouldn't cost extra...

Originally Posted by Birchtree

So why am I so fortunate to be spending $335.70 for my monthly deduction for Medicare Part B. It's $104.90 for standard Medicare premium and $230.80 for the income related monthly adjustment based on my 2011 income tax return. So I'll just deduct these medical costs as I roll through life. My prescription drug coverage is $78.80 and that does not include the costs of the drugs.

Not sure Birch. I may need to look at her annuity stub to check what she said but that sounded right to me! Are you paying for retirement FEHB or is that a separate supplemental??? Why would you pay for RX coverage that doesn't cover costs of drugs?

"Warrenlm hit this on the nose. This is exactly how I understand it works, but I don't know how Tricare or VA benefits figure into the mix as I have no dealings with that.

My mom retired as DOD civilian many years ago. We researched it and determined it was best for her to buy Medicare Part B ( physician/ office visits, outpatient services, durable medical equipment) coverage. Medicare Part B costs her $104 per month right now. Then she kept her FEHB (with BCBS standard option) and that costs her $186 per month for single. So Medicare is first payer, then when they pay, they notify BCBS and BCBS pays what Medicare part A and part B did not pay....so FEHB acts like a supplemental insurance. "

My dad was retired military and retired civil service. He was a triple dipper with Social Security also. He elected FEHB, Medicare Parts A and B, and also had Tricare for Life. He is deceased now but my mom still has the three coverages. Tricare is basically a supplement to Medicare and FEHB. May be overkill but if my Mom has a medical bill it is usually a mistake. Virtually all of her prescriptions are covered with the exception of very small co-pays.

Just got a letter from the VA asking if I want to take advantage of their health care program. I have Federal BCBS coverage now. I have a few years before I have to sign up for Medicare (I'll be 62 this year) and I know I should start seriously researching the Medicare angle. Just not sure if I should take advantage of this and really make things more complicated.