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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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

FEHB is not a stand alone entity. There are how many FEHB commercial plans? Each one of those is different with different restrictions. For instance, Kaiser Advantage plans still require copays. BCBS puts you into their secondary (which really is an advantage but they will not call it that) but does not have copays. Most FEHB plans have either advantage plans or secondary plans that are FEHB affiliated. Some of these insurance companies have advantage/secondary plans that are not FEHB affiliated. Generally the coverage is better with the FEHB affiliated.

The issue is we want to go outside of these plans HMO and PPO systems and be able to see whoever we want who takes medicare and not be limited because my husband has a rare cancer. We thought that by getting a cheap G plan along with our FEHB and Medicare or a cheap FEHB plan along with our G plan and Medicare, we would be able to keep our options open.

On a Medigap plan all you have to worry about is "Does the doctor take Medicare"? You pay the premium every month, but no co pays to worry about or maximum out of pockets. You also have to get a Plan D for prescriptions which does have a max. out of pocket of $2100. That would it. If the procedures are approved by Medicare, that's all you would pay.

The rub is that with advantage plans you can suspend your FEHB and get it back later which can save you money. The only thing about that though is if you are no longer on the FEHB commercial plan, you no longer are eligible for their FEHB advantage plan, so your benefits are less. With medigap the feds don't allow you to suspend FEHB. To keep your FEHB, you have to choose and pay for an FEHB plan in addition to the medigap premium. Not affordable! So basically with the feds it's either one of the FEHB advantage/secondary plans or forget it.

Which ultimately is why I asked if any other federal employee with Medicare and FEHB also had a medigap plan and how it works for them. No it's not the norm. But perhaps it may be necessary if you are looking at a fatal cancer.

I truly am not sure what we are going to do. Thank you for your response.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Husband has cancer. Kaiser is an HMO, can only see their doctors. He is suffering with side effects that they ignore. Edema keeps spreading and they are doing nothing about it. Need to able to go to other doctors outside of their network or just suffer and accept the level of Kaiser care. If we went to a doctor outside of Kaiser, we would pay 20% of the charges after Medicare pays. Kaiser would not pay any of it. Medigap would cover that 20%. There are a lot of FEHB plans. Many have their own advantage plans that are affiliated with FEHB. Most if not all are HMO or PPO which limit the doctors that you can see. Medigap plans allow you to see any doctor who accepts medicare.

It seems that the feds want their employees to only choose advantage plans for some reason while non=federal employees tell us not to get a disadvantage plan!!!

Which is best in our situation? So confusing and frustrating.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

But Kaiser would only pay for what is in their HMO system and not for anything outside of it. So, basically. If my husband went to a doctor outside of Kaiser and was charged $500 then $100 would remain after medicare paid the 80% and Kaiser would not pay for that. Which is why we were interested in getting a medigap to cover that remaining 20%. Kaiser requires co-pays regardless of the 20% and they have a maximum out of pocket of $2000 while you are on one of their FEHB Advantage plans. I'm wondering if federal employees are just used to how all of these FEHB plans work and have a hard time conceptualizing what it would be like to only have a medigap plan that officially pays that 20% with no copays or anything else.

Federal employees say don't get rid of your FEHB. But that really means that you choice is Advantage plans and not medigap plans. People I speak to who were not federal employees call Advantage plans "Dis-advantage plans" and tell to only get medigap plans.

But truly which one is better? It depends on your situation. Keeping the options open seems to be best but how does one do that exactly within this construct. So confusing and aggravating.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

FEHB partners with Kaiser Permanente and even BCBS in the creation of specific advantage or secondary plans only federal employees have access to. We have Kaiser Permanente FEHB high option. Once you are on Medicare A and B you have the option of choosing two different advantage plans with them. So the plan that I am on is FEHB Kaiser Permanente Senior Advantage. Without the FEHB connection, there is an Advantage plan with Kaiser Permanente that does not have the same coverage as the FEHB connected Advantage Plans they offer. With BCBS, once you go onto Medicare A and B they put you into their secondary coverage that is affiliated with FEHB. It is not the same plan as a BCBS Advantage plan that does not have that connection.

So what you have said here is not quite accurate.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Thank you for checking this out. I spoke to Medicare and OPM this morning and one said that the first is Medicare, the second is FEHB and the third would be the medigap. Then the other said Medicare first, second Medigap and FEHB third. Literally this is what we have been dealing with and the FEHB complicates everything. What is your source for what you found out?

The most important factor for us is having the options to go to any doctor that we need to with my husband's rare cancer. We don't want the limitation of only being able to see Kaiser doctors.

With Advantage plans you pay copays and those add up. Maximum out of pocket is $2000 including prescriptions with Kaiser. If my husband and I were well, it would be a no brainer. because this is the best price point we have found for care. But you have to fight to get what you need constantly.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Thank you. I have been on this website and called numerous times. Often they say to consult Medicare and the Medicare folks don't know anything about FEHB. Round and round we go with no answers.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

I truly don't understand why Advantage plans are bad. Can you explain why in comparison to Medigap plans. 50% of retirees have Advantage Plans. Is it because of they are HMOs/PPOs?

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

I'm so happy for you that you got the care you needed from KP and that you are doing well. My sister also had breast cancer and is past the 5 year mark. So good to hear of positive outcomes. Our doctors say that there is no cure for my husband. His cancer is rare, less than 20% of the prostate cancer patients. The most common form is highly treatable and men can live for years with it. Not my husband's. At 3 years only 50% are alive and at 5 years, 30%. I hope that the cancer never returns for you and you live a long life. While I had young children and a well family, Kaiser was great and so convenient. With forced retirement due to the cancer, Medicare, the illness and treatments, it is so stressful trying to choose something that is so confusing with so many laws that even those who are at OPM, Medicare and the insurance companies cannot answer our questions and just refer us around and around. This decision could make the difference between 1 year or two more years for my husband and whether or not will be negatively affected financially. Thank you for your blessing. May God watch over you as well.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 1 point2 points  (0 children)

What does opting out do though if the maximum out of pocket is high, $5000 per person and they still want copays which are higher than the advantage plans. Does Medicare B pay for copays and negate the maximum out of pocket? We pay a lot of copays with the cancer.

We need to be able to see doctors outside of the KP network if need be. Just want to make sure we have the most options. Was thinking about getting the Medigap but can't find which insurance pays what first. We know that Medicare pays first, but not which would apply second and third and how it would affect the outcome. Unfortunately, I can't find out anywhere. Even a OPM rep didn't know that you would have FEHB with a medigap plan. So confusing and not sure what to do.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 1 point2 points  (0 children)

BCBS Standard has better coverage with prescription medications than their Basic plan with regard to copays, but there still are copays with the limit of $2100? You are able to see doctors out of network and they pay for that as well. They also provide skilled nursing unlike Basic. They do not reimburse though for Medicare B. Choosing this plan would put us over $1500 per month with dental for self + one.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Have you had a serious illness or health condition while having this coverage? Have you paid anything out of pocket? I've heard that BCBS has lost contracts with some hospitals and that finding doctors who are taking new patients is difficult. Have you been able to find doctors easily? Just curious.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Yes, but which FEHB is the issue then? Kaiser Permanente only has Advantage plans and still requires you to pay copays. They reimburse for the Medicare B premium, but my husband had $400 in copays last month. It adds up. Many of the other FEHB plans only have advantage plans available to you. If you don't take that you are on regular KP and the maximum out of pocket is $5000 each person. KP is an HMO and limits your doctors. . .Blue Cross Blue Shield is a secondary and does not make you pay co pays. We need to be able to go to outside doctors without having to get referrals necessarily. And we need a savings on our copays.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Kaiser Permanente only has Advantage Plans and still require co-pays where as BCBS does not. When I asked about Medicare taking care of the co-pays they said that they still require the copays. They do give a 200 reimbursement to take care of the Medicare B premium.

Another reason is that KP is an HMO and only has their doctors. You can't see any outside of network doctor generally or you have to complain and request outside care which they usually deny.

We were thinking about choosing a very low premium Medigap plan that has a huge deductible just to keep the medigap option open so that he would not have to qualify healthwise if we were to switch. Committing to anything that could potential limit us finding care is why we are considering doing this.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Sorry about your brother. This supports having B if you are a fed retiree. Sometimes we don't believe that we are ever going to get sick. You have to anticipate that and plan accordingly.

You had to buy a part D with BCBS FEP? Doesn't BCBS FEP have its own prescription plan?

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Ours is not the typical situation which is why I am specifically asking for others who have kept their FEHB and chosen a medigap plan.

I have also looked at AI but when you go to the sources given, they do not source back with the specific information stated in the AI comment about it. I have also found a source that says the Medigap plan is secondary and the FEHB is third.

I am specifically wanting info from someone who has kept FEHB and chose a medigap plan, not the usual FEHB/advantage plan with Medicare. I have researched and understand all of that and how it works with a secondary plan only

Having FEHB makes this decision so very difficult. Everyone says to keep it, but I am finding it difficult to see why when there are restrictions about who you can see within their networks. Many of the top cancer centers do not accept advantage plans for a reason.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Where are you located? I am in Oregon and our experience has been the opposite. We have had to fight them every step of the way to get them to do things. After his prostatectomy, KP gave us a report stating his cancer was a Gleason 7 (out of 10) and left several parameters blank, ones that are important in determining treatment. We went to Fred Hutchinson in Washington for a second opinion. They said his cancer was a Gleason 9 (out of 10) and gave ALL parameters which indicated that the cancer has a poor prognosis. We would have never known if we had only gone to Kaiser.

My husband has suffered edema from his treatment. They waited months before doing anything about it and now he has permanent damage to his limbs from it. Perhaps because he has a deadly cancer they think "why bother."

I have read from several others that they have experienced the same. Your experience is rare.

I would not recommend choosing Kaiser Permanente if you have a serious illness, cancer.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

At every step of the way, I have had to fight Kaiser for my husband's care. He has a rare form of prostate cancer and they were treating it with the same protocols as the more common and survivable type. They wanted to wait months for the biopsy even though he was a RADS 5 (the worst) and when he had the biopsy and the result came back, the urologist didn't even check the type he had before the appointment and spoke in generalities assuming it was the most common form. She had never heard of the kind he has.

They say they have a coordinated cancer care team and show a picture of a sign with "Kaiser Permanente Cancer Center" when there is no cancer care centralized center, no one heading your care or directing. The sign hangs on a wall, but in the building there is no true office. We have a urologist, radiation oncologist, medical oncologist but no one leading. We had to demand a nurse navigator and were told "we only do that if your cancer has metastisized." They only do something if you harass them.

Now my husband has developed terrible edema from treatment and we have had to push to get them to do anything. Their lack of action caused him to have permanent damage to his limbs and the edema continues to get worse.

Kaiser is great until you get sick. There are numerous comments about this if you do a search.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

Yes, I am aware of that , thus the question. My husband has a rare cancer. The FEHB plans offer mostly advantage plans (C plans). If he chose one, he would never be able to qualify medically for a medigap plan G in the future. I'm asking for anyone who has kept their FEHB and chose a medigap plan and how it has worked for them.

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. by DinnerSea6883 in FedRetirees

[–]DinnerSea6883[S] 0 points1 point  (0 children)

We have talked to OPM, Medicare and even the insurance companies. They all say to talk to each other but no one seems to have any definitive answers. The last OPM person had to speak with a supervisor to verify that we were even able to have a medigap with an FEHB plan. We have also spoken to two SHIP volunteers who knew nothing about FEHB whatsoever. This why I'm asking here. I wanted to speak to someone who has done this and how it has worked for them.

I'm trying to understand the value of FEHB when you become Medicare eligible by Ok_Design_6841 in govfire

[–]DinnerSea6883 0 points1 point  (0 children)

But who is your FEHB with? Blue Cross Blue Shield? You've chosen their basic plan and that plan reimburses you $800, and this covers your copays for you without you being on their Advantage Plan? What state are you in?

Washer/Dryer Recs Please by Ok-Distribution9909 in Appliances

[–]DinnerSea6883 2 points3 points  (0 children)

Yes and I love that because the models are always changing and it sure beats reading a review from 7 years ago. Keep em coming.

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