Posted on Friday, 2nd September 2022 by

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I discussed the Medicare Advantage Plans associated with our Federal Employees Health Benefits (FEHB) last year during open season. These are relatively new and low-cost options that retirees can change to if they have a FEHB plan and Medicare A and B.

Many are attracted to them because they are lower cost and offer partial Medicare Part B reimbursement. The issues around these plans deal with coverage and provider availability. You have to use preferred providers in their plans and because the plan becomes your primary provider, you often require preapproval or authorizations for many procedures.


Her husband retired from the postal service 7 years ago.  They carried BCBS basic for their insurance plan as well as Medicare part A & B. Last year they switched to the Aetna Medicare Advantage Z26 plan.  It seemed like a significant savings for us and also offered Silver Sneakers as a perk, so we switched.  Now I am wondering if we did the right thing.

BCBS/Medicare was always excellent in handling our medical needs. Anytime I needed a procedure, I got it done, no questions asked. If my doctor felt I needed the procedure, I had it done, no waiting.  We rarely spent anything out of pocket.

With this Aetna plan, it seems like we have to jump through hoops in order to get things done. I needed an MRI and Aetna insisted I complete 6 weeks of physical therapy or go through a complaint process. In the meantime, my problem got worse with physical therapy. I had to call my orthopedic doctor 3 times in order to ask him to call Aetna so they could approve this MRI. This process started mid-May and I finally got an MRI at the end of August!  Other issues required pre-approval before I could get the services I needed.  I didn’t have this problem with BCBS and Medicare A & B.

With money getting so tight, I hate to have to pay the higher BCBS premiums, but when your health is at stake……. what can you do.


Sorry to hear about your problems. I did not switch to a MA plan for a number of reasons. The article I wrote on the subject titled, “FEHB Medicare Advantage Plans (Proceed with Caution),” discusses some of the issues you are talking about.

Once you go to a Medicare Advantage (MA) plan, that insurance company becomes your primary provider and Medicare pays them to handle your health care needs. How the MA providers make money is to manage their program to cut costs. That’s why you have to go through the additional steps. In your case it is much cheaper for the plan to pay 6 weeks for physical therapy than pay for an MRI.

I remained with GEHA Standard and pay $291.92 for Self Plus One. Medicare remained my primary provider which is beneficial in most cases. For example, your provider insisted you take 6 weeks of PT before they would authorize an MRI. I had an MRI for my back problems last month and was taking PT as well. GEHA does not require pre-authorization since Medicare is our primary provider and I got it two days later. GEHA picks up what Medicare doesn’t.

Unfortunately, my wife has had many eye operations for glaucoma over the past 6 years and I had several operations as well and we paid zero for everything, I also have major back issues. We only pay prescription copayments. Here is a link to the article I wrote comparing BCBS Basic to GEHA Standard.

GEHA Standard to BCBS Basic Plan Comparison – 2022

GEHA Standard doesn’t provide any Medicare Part B reimbursement but is much cheaper than BCBS Basic that for us that wasn’t an issue. Our coverage is exceptional and it would take a lot for my wife and I to change.

Fortunately, you can always change back to a standard FEHB plan next open season.


I received several other emails from newsletter subscribers discussing their problems with the new MA plans. Most were concerned with limited facility availability in their area. One indicated he had to travel over a 100-miles to get a procedure done at a plan’s preferred provider.  Others had similar problems to Vicki.

Before changing plans, check out their provider network as I discuss in the article I wrote on this subject. Many still think Medicare is their primary provider when they switch, they are not. With Medicare you can use any facility that accepts Medicare; you generally won’t need pre-authorization for many services.

Before changing to another plan investigate it thoroughly, cost is certainly a factor but nothing is more important than your health. As I and my wife age, our healthcare needs have unfortunately increased dramatically. I’m writing this article after my wife and I tested positive for COVID three days ago. We had all three shots, the last one only 6 months ago!

The new antiviral Paxlovid was prescribed by our PCP and it is starting to work, however the side effects are a lot to deal with. Mary’s fever was 103.6 last night!

These plans may be cost effective for those who understand their limitations and realize they must use the insurer’s provider network. If things don’t work out to your satisfaction, you can always change back to a traditional FEHB plan next open season.

Prepare for the 2022 FEHB Open Season now.

This past two years we were told many things about COVID that proved not to be true and that sounds much like disinformation today. Yet, the doctors and scientist that warned us about being overly optimistic, potential side effects, questioned the origin of the virus, and supported natural immunity were censored, their social media accounts closed, and many were fired!

In my humble opinion, disinformation is a false premise. COVID is the perfect example. There are many sides to a story and when we stifle other opinions, perspectives, and voices, we close our minds to what might ultimately be the best solution. True scientific inquiry requires listening to all possibilities or we would still be in the dark ages insisting the world is flat.

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