Health Insurance

[GUCHI]

hey Folks

its crunch time!:confused: i just wanted to see if anyone has the Aetna CDHP plan and wanted to know how they liked it???:confused: I have looked at the plan and it looks really good to me. I am currently with Blue Cross. Switching to Aetna I will save $1500/Yr on the premium. and they set up an account for yo of $2000/Yr and you spend out of account first then you go to your $1000?yr deductible. once that is met you go to plan coverage. For me and my family we do not go to the doctors much so I dont think that I will even spend the $2000 in the account. also they rollover remaining money in account from year to year up to $10,000 for self and family.please let me know any info. on this Aetna plan.
thanks :)
john

[Steel_Magnolia]

A while back were discussing Aetna HDHP on this thread:

http://www.tsptalk.com/mb/showpost.php?p=291417&postcount=21

I don't know how much difference the HDHP plan is from the CDHP though.

I have Aetna HDHP and have had it for a few years. I was considering going to Blue Cross this year after last summer's big health bills. But it looks like the catastrophic limit has kicked in just fine. So after looking at all my spreadsheets I'm not going to switch.

Everyone is different and nobody has the same health needs. But for me, Aetna works great and saves me money. And their customer service people are polite and helpful too.

Maggie

[GUCHI]

SM
the plan looks like it will fit my needs as well since my doc visits are very limited at this point, (knock on wood). thanks 4 your input.

[nnuut]

Federal Employees Health Benefits (FEHB) Premiums to Increase in 2015
October 8, 2014

The Office of Personnel Management (OPM) announced yesterday the overall average premium increase for employee health benefits provided through the Federal Employees Health Benefits Program (FEHB) will be 3.2 percent for 2015.
According to OPM, the health insurance increase means employees with self-only coverage will pay an average $2.93 more in each bi-weekly pay period. Employees with family coverage can expect an average increase of $6.89 per pay period. The actual premium increases depend on which plans they choose.
This fall's Open Season for health, dental and vision insurance, as well as for the flexible spending accounts, will be from November 10 to December 8. During that time, employees and retirees will have the chance to review their current plans and make any changes they desire for the following year. Eligible employees who are not currently a part of FEHB may also enroll for the first time.
This is also the first time employees will be able to enroll in the flexible spending account program for just a $100 minimum deposit. And for the first time, participants in the health care flexible spending account will be able to carry up to $500 of unused funds into the following year. More detailed breakdowns of the FEHB Program premium rates and the FEDVIP rates are available here:
Federal Employees Health Benefits (FEHB) Premiums to Increase in 2015 (http://www.myfederalretirement.com/public/1287.cfm)
2015 FEHB Premium Rates (http://www.opm.gov/healthcare-insurance/healthcare/plan-information/premiums/)
2015 FEDVIP rates (http://www.opm.gov/healthcare-insurance/dental-vision/plan-information/Premiums)

[k0nkuzh0n]

I've got the GEHA high deductible plan... so no change for me

[James48843]

Reminder-

Federal Health Plan open season is coming soon, and the new rates are posted here:

(Thanks Nnutt for the heads up)


See Premiums (http://www.opm.gov/healthcare-insurance/healthcare/plan-information/premiums/)

My state has several new plans starting in January. I'm going to have to check them all out this time around- more choices.



OPEN SEASON:


Q: When is Open Season? (http://www.opm.gov/faqs/QA.aspx?fid=fd635746-de0a-4dd7-997d-b5706a0fd8d2&pid=2d2fb461-114d-49bf-993d-765e3daef2c3)
A: Each year, Open Season runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December.

This year Open Season is November 10, 2014 through December 8, 2014

[FireWeatherMet]

I continue to be a big fan of Blue Corss/Shield Basic.

- NO annual deductible. Your first visit goes to copays (Mostly $25...Except $35 specialists).

- Unlike BC/BS standard, you are limitied to those doctors who accept Blue Cross/Shield. But where I live thats about 90% of our doctors and all of our regional hospitals.

- Even covers about 20 Chiropractic visits WITH THERAPUTIC MASSAGE!!

- Some Dental, including 2 cleanings year with just a copay. However dentist list is limited so I use GEHA Dental on FedVip for dental insurance.:D

[nnuut]

OPM Issues Rule on Adding Self-Plus-One Option to FEHB

December 4, 2014
On December 3, the Office of Personnel Management (OPM) issued a proposed rule to amend the Federal Employees Health Benefits (FEHB) Program regulations to add an additional enrollment type called "self plus one" for premium rating and family member eligibility purposes. According to the rule, the self plus one enrollment type will be available starting in the 2015 Open Season for the 2016 plan year. A self plus one enrollment will cover the enrollee and one eligible family member, designated by the enrollee. The proposed regulation does not alter current FEHB family member eligibility guidelines. Eligible family members under a self plus one enrollment will be a spouse or an eligible child.
The proposed regulation provides definitions for a self only, self plus one, and self and family enrollment as follows:


Self only enrollment means an enrollment that covers only the enrollee.
Self plus one enrollment means an enrollment that covers the enrollee and one eligible family member.
Self and family enrollment means an enrollment that covers the enrollee and all eligible family members.

"Under OPM's policies, current enrollees with Self and Family coverage who only have one dependent are expected to have lower premiums under the new enrollment
OPM Issues Rule on Adding Self-Plus-One Option to FEHB (http://www.myfederalretirement.com/public/956.cfm)

[burrocrat]

finally! I for one as a single parent of one child am sick and tired of subsidizing those happily married christian idiots with multiple litters. It's called birth control people! It just never made sense to me why two of us should pay the same as a family of 9. And we're guys so we never go to the doctor unless something is obviously broken or we can't walk no more anyways.


OPM Issues Rule on Adding Self-Plus-One Option to FEHB

December 4, 2014
On December 3, the Office of Personnel Management (OPM) issued a proposed rule to amend the Federal Employees Health Benefits (FEHB) Program regulations to add an additional enrollment type called "self plus one" for premium rating and family member eligibility purposes. According to the rule, the self plus one enrollment type will be available starting in the 2015 Open Season for the 2016 plan year. A self plus one enrollment will cover the enrollee and one eligible family member, designated by the enrollee. The proposed regulation does not alter current FEHB family member eligibility guidelines. Eligible family members under a self plus one enrollment will be a spouse or an eligible child.
The proposed regulation provides definitions for a self only, self plus one, and self and family enrollment as follows:


Self only enrollment means an enrollment that covers only the enrollee.
Self plus one enrollment means an enrollment that covers the enrollee and one eligible family member.
Self and family enrollment means an enrollment that covers the enrollee and all eligible family members.

"Under OPM's policies, current enrollees with Self and Family coverage who only have one dependent are expected to have lower premiums under the new enrollment
OPM Issues Rule on Adding Self-Plus-One Option to FEHB (http://www.myfederalretirement.com/public/956.cfm)

[nnuut]

finally! I for one as a single parent of one child am sick and tired of subsidizing those happily married christian idiots with multiple litters. It's called birth control people! It just never made sense to me why two of us should pay the same as a family of 9. And we're guys so we never go to the doctor unless something is obviously broken or we can't walk no more anyways.
Well said!:cool:

[Minnow]

finally! I for one as a single parent of one child am sick and tired of subsidizing those happily married christian idiots with multiple litters. It's called birth control people! It just never made sense to me why two of us should pay the same as a family of 9. And we're guys so we never go to the doctor unless something is obviously broken or we can't walk no more anyways.

Sorry bud. I, being a guy, don't go to the doc "unless something is obviously broken or can't walk no more anyways." But I do have a litter and I appreciate you working so hard for me and my progeny -- they're tough though and don't go to the doc too much.

[burrocrat]

Sorry bud. I, being a guy, don't go to the doc "unless something is obviously broken or can't walk no more anyways." But I do have a litter and I appreciate you working so hard for me and my progeny -- they're tough though and don't go to the doc too much.

That's ok, I'm over 40 now so I will be going to the doctor a lot more for my colorectal screenings. And if the test is positive it will be your children that end up covering the bill. Thanks for your future taxpayer providing efforts. What comes around goes around.

[nnuut]

I'm allergic to Doctors but sometimes I have to go, they have you by the>>>>>>>>> enough said!:cool:

[Minnow]

That's ok, I'm over 40 now so I will be going to the doctor a lot more for my colorectal screenings. And if the test is positive it will be your children that end up covering the bill. Thanks for your future taxpayer providing efforts. What comes around goes around.

Good way of looking at it (except for the whole rectal exam stuff). :D

[jpcavin]

This thread should be titled "Men's Health":D

[nnuut]

This thread should be titled "Men's Health" Well let's change that, we all need health care and are all in one group.

[burrocrat]

This thread should be titled "Men's Health":D

birth control is not just a man's issue, we're all in this together.

[jpcavin]

Well let's change that, we all need health care and are all in one group.

This one's on the house. [emoji6]
http://tapatalk.imageshack.com/v2/14/12/09/cc6714cb23ee07c3c7ceeaebde657aa4.jpg

[jpcavin]

birth control is not just a man's issue, we're all in this together.

Sounds like you need a beer too. ;)

[Minnow]

This one's on the house. [emoji6]
http://tapatalk.imageshack.com/v2/14/12/09/cc6714cb23ee07c3c7ceeaebde657aa4.jpg

I have it on good authority that a few of these plus some oysters will cause more births.

[FireWeatherMet]

Well let's change that, we all need health care and are all in one group.

Finally, you've said something sensible. :)

[PessOptimist]

I know health insurance has been discussed here and there in other threads. Found this one and thought I’d bump it.

Open season is coming up for FEHP, FEDVIP and FSAFEDS; 9 Nov-14 Dec 20. https://www.opm.gov/retirement-services/publications-forms/benefits-administration-letters/2020/20-401a1.pdf.

I currently have retiree BCBS basic which I am fairly happy with except of course for the premiums. I also have Medicare A and B plus TriCare for Life. SWMBO has BCBS and TriCare Prime. She will soon have the same as me. Yeah I know, am working on suspending BCBS to see how it goes but other beneficiaries are skeptical.

I have been using MetLife Dental FEDVIP for a long time. Not great but OK until 2020. Looking for experiences with other providers listed by OPM for 2021.
Aetna Dental PPO
Delta Dental PPO
BCBS FEP Blue Dental
GEHA Dental PPO
MetLife Dental PPO
United Concordia PPO
UnitedHealthcare Dental PPO*
HealthPartners*
Humana EPO/PPO


This calendar year Metlife FEDVIP has started denying claims, stating my primary insurance covered procedures. Who? I had called a few times but got a recording stating wait times were hours. I sent them a snail mail about one of the claims. Today I called again about another claim and to my surprise got a human on the line within 5 minutes. She said my primary Insurer had paid one and the other one needed an xray. My dentist sent an xray but MetLife said it wasn’t good enough. I asked who the primary insurer was and she said it wasn’t listed and transferred me. I got another human within 60 seconds and he was very helpful. I spent over an hour on the phone while he called others with questions. Never got dumped to my surprise.
First claim issue may have been resolved; time will tell. Metlife person said that starting this year OPM demanded other FEP insurers be billed first. Everyone seemed to agree neither Medicare part A or B, nor FEPblue basic pays for dental exams/cleanings. Both ignore such claims and do not send an EOB denying them. Claim is being resubmitted based on FEPblue statement they would not send an EOB for dental claims as any fool knows dental is a separate coverage.
Second claim was for a crown. Metlife called my dentist while I was on hold and they “found” whole mouth xrays that they are submitting. Again, time will tell. This bill is a biggie so I hope it gets paid.

Anyone else been having dental claims denied this year?

PO

[James48843]

Not having any problems YET, but found out my Dentist will no longer be accepting Delta Dental after January 1, 2021.

I also found out this morning that my 24 year old son (who no longer is on my FEDVIP Delta Dental Plan, because he is 24), is on my WIFE’s Delta Dental through her employer- anyway- HE is going to need a crown, a root canal, and four wisdom teeth pulled in the next two months.

Anyway- just be sure to ask your dentist if they plan to discontinue your chosen dental coverage carrier. I will be looking for a replacement for Delta- I’ve done fine with them, but it sounds like that isn’t going to work for me next year.


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[PessOptimist]

Not having any problems YET, but found out my Dentist will no longer be accepting Delta Dental after January 1, 2021.

I also found out this morning that my 24 year old son (who no longer is on my FEDVIP Delta Dental Plan, because he is 24), is on my WIFE’s Delta Dental through her employer- anyway- HE is going to need a crown, a root canal, and four wisdom teeth pulled in the next two months.

Anyway- just be sure to ask your dentist if they plan to discontinue your chosen dental coverage carrier. I will be looking for a replacement for Delta- I’ve done fine with them, but it sounds like that isn’t going to work for me next year.


Sent from my iPhone using TSP Talk Forums (http://r.tapatalk.com/byo?rid=74921)I did ask the dentist about the carriers I listed. Thanks for that advice. I had Delta under the Tricare Retiree program until they discontinued it in 2018. At that point I dropped the Tricare program as it wasn’t worth it and alternatives were FEDVIP programs so I couldn’t have two anyway. Paid more in premiums than I got in claims having both Tricare Retiree and FEDVIP. Delta was OK paying what it said it would.

Are you enjoying being retired? Don’t let the wife do so if it means dropping the dental plan.

Humorous (to me) thoughts I would have shared with my own son-I have lots of pliers and vice grips, prying tools and a dermal tool. Let’s save some money! Yes, I am a bad person.

I’ll post if I decide to change from Metlife.

PO

[nasa1974]

PO, are you getting a $800 refund on your Medicare Part B with your Federal BCBS basic?

[PessOptimist]

PO, are you getting a $800 refund on your Medicare Part B with your Federal BCBS basic?Yes for 2018 ($600), no for 2019 (wageworks.com says I am not eligible for 2019) and not yet for 2020. I have so much going on as far as insurance claims I have not gotten to why no 2019 refund. Thanks for the reminder.

PO

[Bullitt]

Aww man what a mess. And I'm sure when you called you got some dumb message like, "Due to these unforeseen times, call wait times might be a little longer." Like it's any more effort to answer a phone whether offices are shut down or not.

To me, dental just never seemed like a good deal. Had MetLife for some 10 years and unloaded it years ago. Just been using FEP Blue to cover basic dental costs since. I remember paying something like $20-25 a paycheck and had nothing but cleanings. No co-pay, but big deal, a co-pay is only $30, so we were throwing money out the window.

FEP Blue did change their X-ray policy out of nowhere and I got dinged with something like $80 for an x-ray. Turns out, they cut most x-rays down to one every three years and the dentist didn't realize it. (Fine print in a 300 page disaster of a pdf file.) A few weeks ago dental assistant said, "okay, time for your x-ray" and I declined because I'm not sure if it would have been covered.

Never had any catastrophic or major dental so I don't know how it would all work out but I doubt MetLife would have paid for much. We paid for orthodontics out of pocket under FEP Blue and it wouldn't have been covered completely even if we still had MetLife. I think you needed to have coverage for a few years prior before using for orthodontics so that's another thing to keep in mind before jumping around. You might not even be able to use the insurance unless you've been on their books for two or three years.

[jonfresno]

I have BCBS basic, and Aetna dental. Love Aetna? Maybe like? It helped out when I needed a crown, my wife needed a couple crowns, deep cleanings, fillings etc. I believe they also cover for out of network dentists but you'll pay more than an in-network provider.

My dentist submit everything to BCBS first, BCBS denies the big stuff, then my dentist submits to Aetna. Not sure if this is a good thing, but my dentist thinks Aetna is good. It's just the sucky thing of comparing percentages of what each will cover, and whether your dentist will charge more for the agreed upon rates between provider and insurance company for the services.

Had it for a while. maybe 10+ years.

James - so I assume you'll be coming out of retirement for a year or so to pay for those dental procedures.. :smile:

[James48843]

.

James - so I assume you'll be coming out of retirement for a year or so to pay for those dental procedures.. :smile:


No way. I DO have a few sets of pliers around. Not sure if locking Vice grips are the right tool for wisdom teeth, but I’m willing to give it a shot.


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[nnuut]

I have GEHA, had all of my stinkin' teeth pulled last year. They pay half! $85 a month!!!

[PessOptimist]

I have BCBS basic, and Aetna dental. Love Aetna? Maybe like? It helped out when I needed a crown, my wife needed a couple crowns, deep cleanings, fillings etc. I believe they also cover for out of network dentists but you'll pay more than an in-network provider.

My dentist submit everything to BCBS first, BCBS denies the big stuff, then my dentist submits to Aetna. Not sure if this is a good thing, but my dentist thinks Aetna is good. It's just the sucky thing of comparing percentages of what each will cover, and whether your dentist will charge more for the agreed upon rates between provider and insurance company for the services.

Had it for a while. maybe 10+ years.

James - so I assume you'll be coming out of retirement for a year or so to pay for those dental procedures.. :smile:I should have read your reply on 10/13/20 more carefully. I checked today on BCBS Basic and yes they do pay for two exams and cleaning a year and one xray every three years. I never knew that and afaik my dentist has never submitted a claim to BCBS. BCBS rep states it has covered cleaning and xrays forever. Metlife FEDVIP dental rep says submitting claim to BCBS is a new directive this year from OPM. So I think wtf? Or my goodness. Or something like that.

As my usual procrastination has brought me to 4 hours before the end of open season, SWMBO is asleep and I will not make a change without her approval, looks like MetLife is it for another year. I am still somewhat mystified about why in 2019 and previous years my dentist submitted claims to MetLife and Delta 2018 and previously that all claims were paid with no questions.

I had a crown placed on a tooth my dentist had been suggesting for years as it probably was going to break someday. MetLife paid part and I paid $343. When you are 68 years old and your teeth still work and you don’t have pain, you have to think of the value added for dental procedures. How many enhancements do you put in to something approaching it’s end of life?

Dental insurance will be continued since SWMBO likes to have lots of ortho procedures.

PO

[James48843]

Quick update:

Last week I had a tooth flare up. I previously had a cavity on the side of the tooth, in a location my dentist said he could not fill. It finally got infected, and became horrendously painful.

So I had the dentist yank it out. It took all of about two minutes for him to grab it with pliers, give it a few twists, and then it was gone. My screams were pretty loud, but in 30 seconds, the pain was gone, and I was good as new. Except for not having a molar there.

I feel much better now, thank you.


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[nasa1974]

Quick update:

Last week I had a tooth flare up. I previously had a cavity on the side of the tooth, in a location my dentist said he could not fill. It finally got infected, and became horrendously painful.

So I had the dentist yank it out. It took all of about two minutes for him to grab it with pliers, give it a few twists, and then it was gone. My screams were pretty loud, but in 30 seconds, the pain was gone, and I was good as new. Except for not having a molar there.

I feel much better now, thank you.


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WOW!! U da man. Getting that tooth yanked with no pain meds. :banana:

[nasa1974]

I should have read your reply on 10/13/20 more carefully. I checked today on BCBS Basic and yes they do pay for two exams and cleaning a year and one xray every three years. I never knew that and afaik my dentist has never submitted a claim to BCBS. BCBS rep states it has covered cleaning and xrays forever. Metlife FEDVIP dental rep says submitting claim to BCBS is a new directive this year from OPM. So I think wtf? Or my goodness. Or something like that.

As my usual procrastination has brought me to 4 hours before the end of open season, SWMBO is asleep and I will not make a change without her approval, looks like MetLife is it for another year. I am still somewhat mystified about why in 2019 and previous years my dentist submitted claims to MetLife and Delta 2018 and previously that all claims were paid with no questions.

I had a crown placed on a tooth my dentist had been suggesting for years as it probably was going to break someday. MetLife paid part and I paid $343. When you are 68 years old and your teeth still work and you don’t have pain, you have to think of the value added for dental procedures. How many enhancements do you put in to something approaching it’s end of life?

Dental insurance will be continued since SWMBO likes to have lots of ortho procedures.

PO

At 68 I think all my molars are capped and I've had two teeth pulled and one root canal. At least I can chew a good steak. :D I have BCBS basic and GEHA dental. Been pretty happy with both. Even with dental insurance, mouth work is expensive.

[PessOptimist]

PO, are you getting a $800 refund on your Medicare Part B with your Federal BCBS basic?


Yes for 2018 ($600), no for 2019 (wageworks.com says I am not eligible for 2019) and not yet for 2020. I have so much going on as far as insurance claims I have not gotten to why no 2019 refund. Thanks for the reminder.

PO

I would swear this reimbursement thing was talked about in another thread but no matter.
I never followed up on the 2019 reimbursement. I got it for 2020. Today I got a reminder from HealthEquity, Inc to apply for the 2021 reimbursement. Finding a record of payments was impossible. MyMedicare tells me to go to MySSA. MySSA tells me to go to medicare.

Last year I found a nice record of payment at mymedicare.gov/monthlypremium.aspx. This year the mymedicare site redirects me to medicare.gov which as I stated tells me to go to myss. So I tried submitting a benefit verification letter. We shall see.

Nasa, what did you submit as a proof of payment?

PO

[nasa1974]

I would swear this reimbursement thing was talked about in another thread but no matter.
I never followed up on the 2019 reimbursement. I got it for 2020. Today I got a reminder from HealthEquity, Inc to apply for the 2021 reimbursement. Finding a record of payments was impossible. MyMedicare tells me to go to MySSA. MySSA tells me to go to medicare.

Last year I found a nice record of payment at mymedicare.gov/monthlypremium.aspx. This year the mymedicare site redirects me to medicare.gov which as I stated tells me to go to myss. So I tried submitting a benefit verification letter. We shall see.

Nasa, what did you submit as a proof of payment?

PO

PO,

I got my information from the Social Security website. I logged into my account and downloaded my "2021 Social Security Cost of Living Adjustment" page. I made a copy of that information and then went to my BCBS account.

Service Benefit Plans and Medicare Part A/B - Blue Cross and Blue Shield's Federal Employee Program (fepblue.org) (https://www.fepblue.org/our-plans/medicare/medicare-reimbursement?utm_campaign=unattached&utm_source=(redirect)&utm_medium=vanity&utm_content=medicare-reimbursement-account)

Filled out all the information and submitted it.

[PessOptimist]

I received a refund a couple days ago. I submitted for both spouse and myself and both of us got a confirmation email but so far only one deposit. Should both of us get the refund on a self+1 enrollment? Thought someone on here said yes.

PO

[nasa1974]

I received a refund a couple days ago. I submitted for both spouse and myself and both of us got a confirmation email but so far only one deposit. Should both of us get the refund on a self+1 enrollment? Thought someone on here said yes.

PO

Yes. When I applied for our refunds I had self+1. I had two separate deposits on the same day. Hope the other deposit shows up soon.

[PessOptimist]

FWIW, today a paper check emerged from SO's pile of correspondence. Dated 4/21/22, no idea when it was received. Answer to NASA's long ago question and for anyone else's information. So I got the $800 reimbursement for 2021 from BCBS for Medicare part B for both of us.

PO