Posted on Friday, 1st December 2023 by

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I’ve spent most of my time evaluating our health care options this past two months. This year’s focus was on the new Medicare Advantage (MA) plans offered by GEHA and the Medicare Prescription Drug Plan (MPDP) offered by Blue Cross and Blue Shield and 16 other providers. So much to consider and research before staying the course with our current plans or moving to a new option.

FEHB Open Season

Observations

Medicare Advantage (MA) Plans with their Part D prescription coverage offer considerable savings. I outlined the GEHA MA plan benefits in my article titled, Comparing FEHB Plans to their Medicare Advantage (MA) Option.

It would seem the best of both worlds, Part B subsidies that increase monthly Social Security checks, lower prescription costs, gym memberships, and other attractive benefits. Unfortunately, there are drawbacks, especially for those with health issues that often require pre-approvals for tests and medical procedures.

Who Pays for Added Benefits and Subsidies?

According to the Medicare website, “Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.”

To provide the same level of services and extended benefits, they must reduce costs, operate efficiently, and review the medical necessity of tests and procedures ordered by your doctor.

In most cases, you can only use doctors who are in the plan’s network and in many cases, you may need to get approval from your plan before it covers certain drugs or services. This added layer of approvals and subsequent appeals can delay tests and procedures for critically needed services.

Feedback

I received a number of replies to my request for input about FEHB MA plans.

One of our newsletter subscribers opted into the Mail Handlers Standard MA plan last fall. He did extensive research and finalized the decision using the CHECKBOOK’s FEHB plan comparison service. His wife had extensive medical expenses due to unexpected heart disease after enrolling.

They paid nothing for her procedures or hospital stay. Their prescription costs range from $0 to $50 for 90-day periods. Just two were $50 because they are new brand name drugs.  He is satisfied with the plan and staying enrolled for 2024.

Note: Order Checkbook’s guide at Guidetohealthplans.org and save 20% by entering promo code FEDRETIRE at checkout. The online and print Guide is available.

Dona’s husband had his first knee replaced without incident. At the time they were enrolled in the Aetna FEHB plan before the MA option was available. Medicare was their primary provider.

They signed up for one of the FEHB sponsored MA plans and all went well the first year. Her husband’s other knee required replacement and his doctor submitted the request for approval to his Medicare Advantage plan office. A week before the scheduled surgery, his custom knee was denied.

They appealed the decision, and it was turned down again. Another off-the-shelf orthotic device was submitted; they had to cancel the operation again. Dona transferred back to the their original FEHB plan during the next open season.

Dan agrees that the GEHA MA plans look very attractive! He was enrolled in BCBS Basic and has evaluated other plans because of increasing premiums.

He is switching to GEHA Standard this year and signing up for their MA plan after considerable research. He stated, “Between the savings in monthly premiums, being able to drop my FEDVIP Dental plan and my COLA for next year I will be looking at around a $400 increase in my retirement check each month.”

A blog visitor replied, “I too have been a GEHA Standard enrollee for many years and I was very interested in the new MA advantage plan. It all looked good until I started checking the in-network providers.”

He went on to say, “Not a single quality hospital in my area is included in the network (and only about 1/2 of my physicians). Yes, I know that you can ask the provider to accept payment from UHC and that you also have the option of paying the bill directly and then being reimbursed but do I really want to be bothered with that every time I have a test or need a service from one of the non-network providers.”

He is going to explore other MA plans in his area or stay with GEHA standard.




What Option is Best for You, MA or MPDP?

After weighing all of the factors and exploring plans, the Medicare Prescription Drug Plan (MPDP) is an attractive choice for me and my family. Even though I would be subject to a Part D income-related monthly adjustment amount (IRMAA), it would still provide significant prescription savings overall as I noted in my previous article.

Unfortunately, it is only offered by 17 plans in 2024 and GEHA isn’t one of them. I won’t abandon my GEHA plan to take advantage of it, I’m satisfied with their Standard plan and its low monthly self plus-one premium of $326.79. Changing to BCBS Basic, which offers this feature, would increase my monthly payment by $186.91 to $517.13.

With the MPDP, Medicare A & B remains your primary provider and the FEHB plan picks up all of your copays, coinsurance and deductibles. You typically don’t have the pre-approval issues that you may experience with MA plans.

Drug costs are much lower under Part D, especially with the added enhancements included by your FEHB plan, and you are able to pick it up without a late enrollment penalty!

Hopefully, GEHA and others will offer the MPDP option in 2025.

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Conclusion

Most are drawn to the FEHB MA options for the cost savings. Who wouldn’t want your PART B Premiums reduced and, in some cases, eliminated? Then you add in the significant prescription cost savings, and other benefits.

Initially, I felt it worth the risk to sign up for the MA option due to the ability to opt out at any time during the year and return to your original FEHB plan. Dona, one of the respondents to my query about MA plans, mentioned they switched back to their original plan after having the problems with getting her husband’s knee replaced.

She stated, “He got his new card and assumed all was ok and he was out of Medicare Advantage.” The plan still had her husband partially enrolled in the MA plan and she proclaimed, “Getting this corrected was a nightmare process that took months and months and many calls to finally fix. He once again had to delay his knee surgery.”

Yes, the MA plans are attractive and may be a good fit for you and yours. Take your time to explore the options, review the information provided by each carrier, and call to ask questions that you need the answer to before enrolling.

Good health is fleeting and you never know what is around the corner at any age. I’ve been back and forth on the issue of signing up for an MA plan all year. I’ll be staying with my GEHA Standard plan again this year, and hope they will offer the MDPD option during the 2025 open season.

Previous Open Season Articles

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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.

 

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Posted in BENEFITS / INSURANCE, ESTATE PLANNING, FINANCE / TIP, RETIREMENT CONCERNS, SOCIAL SECURITY / MEDICARE, WELLNESS / HEALTH | Comments (4)


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4 Responses to “MA Plans and the Prescription Drug Plan – Continued”

  1. Nancy Says:
    December 2nd, 2023 at 9:32 am

    These insurance decisions kinda ruin the holidays. My husband and sit huddled over the iPad and Checkbook book trying to evaluate plans. We talk about Mr Damp like we know him. “What does Dennis say?!” We’ve been happy with GEHA standard until I had to see a rheumatologist. No one wanted to deal with United Healthcare as a copayor. I finally found a provider but I have to wait 10 months to see him. We have not had this problem with other providers. Now, with the MA plans mixed in, it’s more confusing and scary. Right now, we’re staying with GEHA standard and GEHA dental til we see how things shake out. Thank you, Dennis, for all your hard work.

  2. Nancy Says:
    December 4th, 2023 at 10:30 am

    I saw this article in a consumer news aggregation and can’t forward a link. It’s from USA news re: Medicare drug plans and insulin, it’s quite alarming. I’m forwarding the headline so anyone with a subscription can look it up.

    Insulin users beware: your Medicare drug plan may drop your insulin. What it means for you
    Medora Lee
    USA TODAY

  3. Dennis Damp Says:
    December 4th, 2023 at 11:15 am

    Here is the link to the article you reference: beware: your Medicare drug plan may drop your insulin. What it means for you

  4. Ann Says:
    December 5th, 2023 at 8:39 pm

    I did considerable research on the Medicare Advantage (MA) plans because my initial response was “Are MA Plans Too Good to be True?” How are the companies making a profit? Found considerable information that makes me very leery. Dennis Damp had a link in another article about denying claims that required prior authorizations, which appears to be a significant problem. HHS OIG reported the problem in 2022.

    NY Times: “‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions,” 10-8-22, NY Times “review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.
    The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits. … 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud. The fifth company, CVS Health, which owns Aetna” I was considering Aetna Medicare Advantage. Read the companies might go broke if the government makes them repay the money.

    DOJ has filed lawsuits against 5 companies. Many hospitals and doctors will no longer accept MA plans. Typical monopoly problem and screwing taxpayers when taking over programs from nonprofit government management.