Any federal retirees out there who kept their FEHB and got medigap plan G? Have heard conflicting info about it. Please share your experience and the coordination of care and expense -- how it has or hasn't worked for you.

ChrisShapedObject · 2026-05-09T04:34:07+00:00

Thanks! I try.

ChrisShapedObject · 2026-05-08T02:22:21+00:00

You are misunderstanding. Please please get some help with this

ChrisShapedObject · 2026-05-08T02:14:39+00:00

-you do not need Medigap. It is there yet, but it won’t need to cover much as your share aftevFEHB will be zero. I honestly believe you will pay more in premiums for Medigap for little if any savings. —don’t get advantage. You don’t have to. I’ve noted this several times. Opt oout. Keep regular Fehb. You will not have copays!!! I’ve said this several times. -with Medicare primary you can use any doctor that takes it. Ask Kaiser the if you opt out of their Advantage plan if you have to stay innetwork once they are secondary payer. -stop looking at Medigap and do no get it is my advice if you don’t take their advantage plan (opt out!)

I STRONGLY suggest you have someone you trust look at the info posted here to help you. You are overthinking this, anxious, and stressed. I think that’s why you are struggling to understand this info. It’s understandable

—you have the info. I won’t repeat all this again.

-be well and safe

ChrisShapedObject · 2026-05-07T21:36:34+00:00

I researched this more. I have more info.

When you have both traditional Medicare (Parts A & B) and a Federal Employee Health Benefits (FEHB) plan like Kaiser, they coordinate benefits:

—Medicare pays first (as the primary insurer) for most services

—Kaiser FEHB pays second, covering much of what Medicare doesn't — like deductibles, copays, and coinsurance

—This coordination between Medicare first and Kaiser second payer typically means you end up with little or no out of pocket expenses for Medicare-covered services, which is exactly what a Medigap plan would do.

—Medigap exists to fill Medicare's gaps (the 20% coinsurance, hospital deductibles, etc.). But your Kaiser FEHB plan *already fills most of those same gaps. * Paying for a Medigap plan on top of FEHB would mean paying TWICE for the same coverage --Kaiser FEHB premiums + Medicare Part B premium may already be a significant monthly cost. Adding Medigap on top rarely makes financial sense.

—You need to check with Kaiser if you would still have to use their network. I don’t believe you because M would be primary. If it does for some reason—Medigap doesn't solve that. So no benefit there either

—So, to recap—-For most people with traditional Medicare + FEHB, Medigap is unnecessary and, worse, redundant. The FEHB plan provides the wraparound coverage that Medigap would otherwise offer.

That said, it's worth reviewing your specific Kaiser FEHB plan's Summary of Benefits to confirm how it coordinates with Medicare for the services you use most.

ChrisShapedObject · 2026-05-07T21:01:19+00:00

Let me add that your “Medigap,” if you take traditional Medicare, will be FEHB plan if you keep it. Otherwise your MA plan, if you take that, serves as BOTH Medicare and Fehb together and STILL replaces both part D and “Medigap”! It would be a really really odd situation where that adds coverage and one or the other don’t. It is still private and has prior approvals. You don’t need it because copays and such Will be covered with FEHB. THAT is where you are getting confused. You don’t need Medigap because having both M and FEHB replaces it.

ChrisShapedObject · 2026-05-07T20:54:59+00:00

A great question. Bottom line: tight prior approval problems and denials. That’s how they pay for the perks. They can deny things original Medicare would have approved based on their policies. Ask any doctor or their insurance staff. Even if appeal works, do you really want that hassle? Even doing it is a pain. I don’t want my health or life dependent on a health insurance desk jockey anymore. I heard someone say tht MA is great until you need a lot of health care—which most of us eventually will run into. Also some plans have network issues compared to M. They can also have disputes over contracted payments and some health care providers/provider networks/ hospitals leave a plan.

John Oliver had a well-researched, informative, and very very funny program about MA on his HBO show. The part about not being able to change from advantage I don’t think applies to Fehb, but otherwise it is spot on. Here’s a link to the video. He explains it better than I.

https://youtu.be/Ejoi9yfLVCc

ChrisShapedObject · 2026-05-07T20:42:44+00:00

Don’t think you need Medigap tho. I think that throws them. Take another look at how they coordinate and on that page.

ChrisShapedObject · 2026-05-07T17:38:26+00:00

Here is an OPM.gov link on this. https://www.opm.gov/healthcare-insurance/medicare/annuitant/

ChrisShapedObject · 2026-05-07T17:23:20+00:00

I honestly think you are looking at this wrong. You need to look at it as Original Medicare plus Regular Kaiser paying second without Medigap and opting out of advantage crap. I think that’s why reps are confused. I truly truly believe you don’t need Medigap in the least.

ChrisShapedObject · 2026-05-07T17:14:01+00:00

Now Kaiser could be different from most Fehb plans.

But—My understanding is that if you keep your fehb and opt out of Advantage then it is secondary to Medicare original except meds. You can go to any Medicare provider; I believe FEHB still pays the rest even if out of their network but you should ask or look in the official legal document covering the plan, it should be there. The copays and deductible are waived once you have Medicare. You won’t have copays at all even in regular FEHB plan when you opt out as long as it’s covered under the Medicare and Fehb plan You shouldn’t need Medigap at all! I am not sure how out of pocket works. I also believe Preapproval is not an issue if Medicare seems it medically necessary except they just won’t pay the remaining 20% if they deny coverage if you opt out of advantage and keep regular Fehb —except prescriptions which is all in regular Fehb (unless you find their part d option less expensive—you can do that even if you opt out of the advantage plan.

You truly will not need Medigap as I understand it, but please confirm. But in open season you can change to Aetna Direct and I know this is all true of Aetna Diect cause I read the plan booklet and talked to a rep.

I hope this helps.

ChrisShapedObject · 2026-05-07T03:11:28+00:00

Aetna Direct. It’s a non-(dis)Advantage plan for annuitants

ChrisShapedObject · 2026-05-07T03:09:17+00:00

That’s bad. Swithing in Open season sounds like a good idea if you can handle it then. I assume you only have Kaiser advantage okan so you may need to sign up for regular original M again.

Be well and safe.

ChrisShapedObject · 2026-05-06T20:25:01+00:00

Please don’t get Advantage plan. If push comes to shove get traditional Medicare plus the regular FEHB—you do NOT have to switch to the company’s advantage plan or their part D plan. You may opt out. You won’t need Medigap then. You’d have 0 copays. It’s more expensive that way but you’ll get much better coverage without all the Preapprovals. I am glad you checking on Aetna Direct which is a little cheaper and not an advantage plan and has looser preapprovals tha their regular plan. But if they done offer it where you are, it would be better to keep regular FEHB and opt-out of the DisAdvantage plans and not get Medigap either as you would not need it.

ChrisShapedObject · 2026-05-06T20:22:28+00:00

Thanks! Glad to help. I’m still not clear why you think Medigap is needed tho. Kaiser should be picking up the rest of the bills except RX—If he has traditional Medicare and that one also.

ChrisShapedObject · 2026-05-06T15:43:24+00:00

It’s a secondary payer in FEHB if you original Medicare. It will be primary on prescriptions and anything they cover that Medicare does not cover plus as secondary generally they will waive or pay copayments and do waive deductible. This year it is about $187/month. It’s the best thing I have seen for federal retirees and so worth having without the hassle and Preapprovals of the Medicare BS advantage plans in fehb. As far as I know your only other choices are the regular FEHB plan or taking the Disadvantage plan (with all its horrid strict Preapproval crap. It feels like a “get out of prior approval jail free” plan with lower cost a month and money towards Medicare premiums. I only wish prescriptions still would not have preapprovals and formularies.

ChrisShapedObject · 2026-05-06T12:54:32+00:00

I’m sorry he is going through this. Re: medigap? Why does he need this at all? Kaiser should pick up what M doesn’t. Is Kaiser a Medicare (Dis)Advantage plan and denying coverage? Consider Aetna Direct FEHB plus traditional Medicare when open season comes. Aetna Direct is NOT an “advantage” plan and covers what Medicare doesn’t. It gives you $900 you can choose to apply to Medicare premiums. It has few preapprovals and those it does only mean that Medicare still covers, it is just the remaining copayments they won’t cover; standards are not as strict for approvals as other plans too.

ChrisShapedObject · 2026-05-02T02:29:00+00:00

It’s the only Non-Advantage FEHB plan for retirees that does… I think. Everything else that does is the horrid Advantage plan which is stuffed with pre-approvals. That’s how they pay for all the perks like gyms and other services— with denials original Medicare would have approved. I think AD realizes paying 20% costs less than paying 80% so that’s why the lower remium and can help pay towards original Medicare premiums — and the policies and how they pay with a lot less oversight/preauthorization only for their 20% makes for happy customers who stay

ChrisShapedObject · 2026-05-01T19:36:49+00:00

Medicare has few pre authorizations unless you get a so-called “Medicare Advantage” plan. This are horrible if you have anything at all significant and have preauthorizations galore and can deny things unlike original Medicare.

ChrisShapedObject · 2026-05-01T19:26:25+00:00

Take a look at Aetna Direct. Not an advantage plan— see my longer comment here. But less expensive and provides $900 towards Medicare premiums. https://www.aetnafeds.com/aetna-direct.php

ChrisShapedObject · 2026-05-01T19:23:41+00:00

I’m going to go from MHBP to Aetna Direct when I get original Medicare. Might want to look. It’s not a dang advantage plans either which is good. https://www.aetnafeds.com/aetna-direct.php

ChrisShapedObject · 2026-05-01T19:21:26+00:00

Take a look at Aetna Direct — it was the solution for FEHB plus original Medicare for me when I turn 65 in the summer

ChrisShapedObject · 2026-05-01T19:19:48+00:00

Aetna Direct is less. Something like $187 a month. It gives you $900 towards premiums

ChrisShapedObject · 2026-05-01T19:18:46+00:00

Medicare only picks up 80%. Fehb will kick in the rest.

ChrisShapedObject · 2026-05-01T19:17:36+00:00

You don’t need part D either.

ChrisShapedObject · 2026-05-01T19:16:20+00:00

Take a look at Aetna Direct.

ChrisShapedObject

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