Posted on Friday, 27th November 2020 by Dennis Damp
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There were a lot of questions concerning the new Medicare Advantage (MA) plans that we reviewed in my previous article. I recently ran a comparison of the Aetna MA (Z26) Plan to GEHA’s Standard (316) Plan and Blue Cross & Blue Shield’s (BCBS) Basic (113) Plans using OPM’s FEHB Plan Comparison Tool and Checkbook’s Guide to Health Care Plans. You can order Checkbook’s online access and guide at Guidetohealthplans.org and save 20% by entering promo code FEDRETIRE at checkout.
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The new MA plans mentioned in the last article require that the employee or annuitant retain their FEHB plan coverage within that group. For example, if you sign up for the Aetna Z26 Self Plus One plan you are automatically enrolled in their Medicare Advantage component at no additional charge if you are enrolled in Medicare. The MA portion for these new plans is often free to subscribers. You only pay the FEHB plan premium. Check each plan for specifics. Basically, I believe these new MA plans simply provide the cost sharing that many other providers automatically offer once you sign up for Medicare.
Introduction
The OPM guide provides a comparison of all plans within a group, you can’t select just Self Plus One for example. Their tool compares up to three plans simultaneously. It is easy to use and lists plan premiums, enrollment codes, links to brochures, provider directories, RX pricing tools, phone numbers, and general plan information for both in and out of network providers. You must then calculate all of the other costs that you may incur such as Medicare Part B premiums subtracting any Part B reimbursements and then estimate other potential costs. Their tool also lists savings incurred when the member is enrolled in Medicare: waivers of deductibles, copayments, coinsurance and out-of-pocket maximums for each plan.
The Checkbook comparison is targeted to an individual’s personal situation: enrollment category, whether or not you have Medicare, your age, and you select either of three health care categories: expected average, low, or high health care expenses. They identify all plans that you are eligible to enroll in after entering your zip code and they provide links to plan brochures, benefit summaries, and formulary and provider directories.
The Checkbook comparison tool user selects whether or not they have Medicare and which parts they are enrolled in. After entering their estimated annual adjusted gross income (AGI), the program determines if your Medicare premium will be income adjusted. Medicare Part B premiums in 2021 range from a low of $148.50 to as high as $504 a month depending on your annual income.
The program compares up to four individual plans at a time. It is very comprehensive and provides an estimated total cost per plan, a benefits summary, and ratings for each service.
Plan Comparisons
I compared the three plans using the following parameters:
- Retired
- Self Plus One plans with both having Medicare Part A and B
- Plans available for zip code 15108 (Pittsburgh Area)
- An AGI of $176,000 and less for a couple – Part B Premium of $148.50/person
- Age 71 with low and average healthcare expenses
There is considerably more detail in the Checkbook analysis. The two reports list monthly plan costs as follows:
- OPM – GEHA Standard $291.92 / Checkbook $589 (Includes Part B Premiums)
- OPM – Aetna Advantage (MA) $275 / Checkbook $572 (Includes Part B Premiums)
- OPM – BCBS Basic $409.87 / Checkbook $707 (Includes Part B Premiums)
The figures reported by checkbook include the Medicare premiums paid by the couple. You would have to add your Medicare premiums to the OPM listed plan premiums. Then for the final cost you must subtract the $800 annual per plan member credit BCBS provides for Part B enrollees. The Aetna plan offers a $900 annual Part B reimbursement per member. GEHA Standard doesn’t offer a Part B partial reimbursement.
Checkbook goes further by listing annual health care costs for those who use no services during the year to those who anticipate low, average or high expenses. These costs include expenses not covered by your plan for doctors, hospital, prescriptions, and other services. This figure includes your FEHB premium, Part B premiums if applicable, minus any Part B reimbursements. Here are the Checkbook figures for low and average yearly costs:
- GEHA Standard $7,920 (Low) / $10,670 (Average)
- Aetna Advantage MA $5,650 (Low) / $6,650 (Average)
- BCBS Basic $7,320 (Low) / $8,330 (Average)
The report also lists yearly costs for those with only Medicare Part A, extra cost for Part B, and any Part B rebate if applicable. Plus, you will find a chart listing important information on cost sharing. They all have wrap around benefits for those on Medicare and cover most of your deductibles, copayments and coinsurance.
Regular services are available nationwide for GEHA and BCBS, Aetna has service available in many areas. Some of the other differences are that Aetna doesn’t provide dental benefits. GEHA and BCBS provide partial reimbursement for specified dental procedures.
Hearing aids are covered by all three providers however BCBS has a 5-year replacement policy and the other two offer new aids every three years. Aetna covers 100 days in a skilled nursing facility while GEHA covers 21 and BCBS covers the first 21 days and then charges $176 per day for day 21–100: and members pay all costs from day 101 and up.
The yearly maximum out-of-pocket expenses are also a consideration. Here are the limits for each of the three Self Plus One plans: (See the explanation in the following paragraph that describes why the figures differ between the two comparison programs.)
Out of Pocket Expenses
- OPM – Aetna MA $15,000 / Checkbook $18,160
- OPM – GEHA $13,000 / Checkbook $20,070
- OPM – BCBS $11,000 / Checkbook $17,880
Insurance plans have a stated limit that you might have to pay including all costs as listed in the OPM column above. But some plans have loopholes that may leave you paying copays and deductible amounts above their limits. The Checkbook “Most you can pay in a year” figure under their column in the above table includes an estimate of the potential cost of significant gaps or loopholes, etc. It doesn’t include dental costs because there are no plan limits on these.
It’s important to review the report and provider benefit guides to ensure they cover the level of services needed. We travel, and require access to in and out of network healthcare services. BCBS Basic doesn’t offer out-of-network coverage. Aetna MA provides services in many areas and is listed as a state specific HMO. Enrollment in the Aetna MA Plan is limited: You must live or work in one of their geographic service area to enroll. With GEHA Standard members that are enrolled in Medicare A & B pay $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network, $0 for inpatient and outpatient hospital services, surgeries and office visits, and if you travel overseas you pay $0 for deductibles and copays outside the United States. BCBS also offers overseas coverage.
GEHA and Aetna both provides 90-day supply of covered drugs by mail. According to the 2021 BCBS brochure their Basic mail service prescription drug program is limited to Medicare Part B members only. If you use a specific formulary drug and decide to change plans contact the new plan to find out if your prescription is covered and what your copayments will be.
All three plans have their good points and any one of them provide acceptable coverage. When accessing plans, I look for the plan that best fits our needs and Its affordability.
I mentioned this in the previous article but it is worth repeating here. If you are considering other Medicare Advantage Part C plans that don’t require FEHB participation, and desire to discontinue your FEHB component, you may wish to suspend your FEHB Plan instead of canceling it. This way, if the MA coverage incurs more costs than anticipated or benefits are insufficient, you have a path back to a viable FEHB Plan provider during the next open season.
Another precaution, be careful when considering Medicare Supplement Plans. They are totally different from Medicare Advantage Plans and you can’t suspend your FEHB coverage and will not be allowed to return to the FEHB program if the Medicare Supplement Plan proves too costly and has insufficient coverage. Many Supplement Plan sales representatives are unfamiliar with the FEHB program and its many advantages.
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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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