- Federal Employee's Retirement Planning Guide - https://fedretire.net -

GEHA Standard to BCBS Basic Plan Comparison – 2022

Share [1]

This summary compares the 2022 GEHA Standard and Blue Cross Blue Shield (BCBS) Basic plans. There are many other plans to consider. I used these two nationwide providers because BCBS has the most subscribers and GEHA has one of the lowest premiums for their standard plan.

[2]

Many annuitants change to a lower cost FEHB plan [3] when they sign up for Medicare A and B because most plans waive the majority of the deductibles, copayments, and coinsurance when Medicare becomes your primary insurer. Medicare pays first and then your FEHB plan pays a portion if not all of the remaining bill for you.

This time of the year those 65 or older receive many offers from private insurers for Medicare Supplement Plans. When you sign up for a private insurer’s Medicare Supplement Plan your only option is to cancel your FEHB plan, you can’t suspend coverage. I wrote two articles, CAUTION – Don’t Lose Your FEHB Coverage [4] and FEHB Suspensions [5] that discuss the severe consequences a number of our readers suffered by doing so. The suspension article provides a detailed list of things you must know before making this move. Many private sector Medicare Supplement Plan brokers don’t understand the FEHB program and end up selling you a product that doesn’t provide the comprehensive coverage you now have. If you know of anyone considering leaving the FEHB program forward this article to them.

Each plan publishes a guide for Medicare enrollees. Here are links to BCBS and GEHA’s Medicare Brochures:

Costs

BCBS Basic limits deductibles, copayment, and coinsurance waivers for Medicare enrollees to in network providers while GEHA Standard includes waivers for both in and out of network providers plus they pay doctor visit copayments. Here is where it does get complicated. When you are enrolled in Medicare you can go to any provider. Just be aware that some plans, like BCBS Standard plans, may not waive deductibles, copayments, and coinsurance fees for out of network providers and that can be expensive. Check Section 9 of your FEHB plan brochure to verify coverage.

Medicare Part B Premiums add to your monthly healthcare costs which for 2021 are as low as $148.50 to as high as $504.00 due to Medicare’s Part B income adjusted premiums [8]. The estimated 2022 Part B premiums are anticipated to increase to a low of $158.50 to as high as $538.90 per month.

To qualify for the lowest Part B premium in 2021 those filing an individual tax return must have a Modified Adjusted Gross Income (MAGI) of $87,000 or less and married couples $174,000 or less.  Gross Income (GI) is calculated before MAGI. Gross Income (GI) is total income earned through wages, dividends, interests, royalty and rental, business income, capital gains, and others. MAGI is calculated by adding back certain deductions such as tax-free municipal bond and student loan interest, tuition, rental loss and IRA contributions to name a few.

Total monthly health care premiums for those on Medicare and enrolled in the Self Plus One plans featured in this article are listed below:

BCBS Basic ($424.95), an increase of $15.08 from last year. GEHA Standard remained the same at ($291.92).

Medicare Part B ($148.50) currently for 2021 for those without an income adjustment.

For a Self Plus One enrollment, the total cost for coverage would be $424.95 for BCBS, $148.50 times 2 or $297.00 for Medicare. Here is what you would pay monthly for your FEHB plan assuming both signed up for Medicare Parts A & B and the couple is earning less than $174,000 a year:

BCBS – $424.87 + $297 = $721.87 monthly, $8,662.44 / year)

GEHA – $291.92 + $297 = 588.92 monthly, $7,067.04/ year)

If BCBS Basic members apply for and each receive a $800 Medicare Reimbursement for a Self Plus One enrollment, their adjusted annual costs would be reduced to $7,062.44 in the above example. That’s $1600 a year for a Self Plus One enrollment when both have Medicare. To obtain the reimbursement you must provide proof that you paid Medicare premiums in 2022 by submitting a Medicare Reimbursement claim. Claims are submitted online by registering for a Medicare Reimbursement Account at fepblue.org/mra [9] or through the EZ Receipts app. You can also mail or fax in a claim form. GEHA provides a $800 per member reimbursement only for their high option plan.

Another viable low-cost option is to consider Medicare Advantage (MA) plans. Aetna, Kaiser, and UnitedHealthcare offer special Medicare Advantage plans for retirees. Some of these plans reimburse almost the entire Medicare Part B premium and waive all doctor and hospital expenses. By doing so, some of these plans have the lowest estimated yearly cost for retirees. In order to join one of the new MA plans, retirees must sign up for the regular version of the FEHB plan, be signed up for both Medicare Parts A and B, and then sign up for the MA plan with their carrier.

[10]

2022 Plan Changes

For a complete list of changes for both plans review section 2 of each brochure.

Observation

Many federal annuitants are hesitant to sign up for Medicare Part B due to the additional cost and what appears to be duplicate coverage. I personally know a number of retirees that are paying large copayments and coinsurance fees because they didn’t sign up for Medicare Part B at age 65.

If you review coinsurance and copayment costs within your current FEHB plan you can see where the costs could be prohibitive for major medical problems. For example, in the GEHA Standard Plan those who don’t have Part B would have to pay a $15 copayment for a PPO primary care physician visit; a $30 copayment to see a specialist for covered office visits and 15% of other covered professional services including X-ray and lab.  If the service is provided by a non-PPO, the member has to pay 35% of covered professional services. With Part B these fees are waived.

Summary

My wife and I enrolled in GEHA basic to reduce cost when we applied for Medicare. Plus, we travel, and require coverage for in and out-of-network providers. Prior to signing up for Medicare, we were enrolled in the BCBS Standard plan because they have no annual deductibles and overall costs were lower. Even though the BCBS basic plan doesn’t cover out-of-network providers, 96% of hospitals, 95% of doctors and 57,000 retail pharmacies are in their network.

Over the past 18 months, providers billed us in excess of $150,000 for services rendered, we paid nothing for the three operations, doctor’s visits, and required tests. I use hearing aids and the GEHA Basic plan offers $2,500 towards the purchase of hearing aids every three years, BCBS Standards has the same reimbursement for hearing aids but limits them to once every five years. With Medicare A & B, GEHA benefits are the same whether or not your provider is in their network.

Those who use high-cost prescription drugs should ensure their medications are on their plan’s formulary list.

There is more to your selection than meets the eye. Take your time this open season to thoroughly review your options and costs. Use the following plan comparison tools to obtain a comprehensive analysis for plans of interest.

Plan Comparison Tools

OPM’s Plan Comparison Tool [15] includes much of the information you would need to make an informed decision with some limitations. The Consumers’ Checkbook 2022 Guide to Health Plans is more comprehensive and provides additional costing information for low, average and high levels of health care usage. The Checkbook guide does all of these complex costing calculations for you on line and provides side-by-side evaluations with ratings for each plan. It calculates total healthcare cost including your income adjusted Medicare premium, any Part B reimbursements available, and FEDVIP costs.

The Consumers’ Checkbook Guide is available in print and online formats. Federal Retirement readers can order their Guidetohealthplans.org [16] and save 20% by entering promo code FEDRETIRE at checkout. The Guide was released November 9th. Print books are mailed as early as the week prior to the start of Open Season.

Helpful Retirement Planning Tools

[23]

Disclaimer: The information provided may not cover all aspect of unique or special circumstances, federal regulations, medical procedures, and benefit information are subject to change. To ensure the accuracy of this information, contact relevant parties for assistance including OPM’s retirement center. Over time, various dynamic economic factors relied upon as a basis for this article may change. The advice and strategies contained herein may not be suitable for your situation and this service is not affiliated with OPM or any federal entity. You should consult with a financial, medical or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Last 5 posts by Dennis Damp