Federal Blue Cross and an Advantage Plan

[Patrick Flammia]

Have a prospect I just ran into who has a Humana HMO MAPD, and federal Blue Cross.

Has anyone ran into this before? Humana is paying first and BCBS picks up all of her copays. She likes it, but she's paying $300 per month for the BCBS.

She likes the extras from the MAPD. So I'm thinking of offering a PPO so she can at least get away from an HMO.

I think a better option though would be to switch to the "basic option" BCBS plan and it saves them around $800 per year on Part B (I think I'm correct on that?). Then she can just have Medicare as primary, and BCBS as secondary to avoid managed plan altogether. Use the money she saves there to set her up with a DVH plan so she doesn't feel like she's losing anything from the MAPD.

Advice?

 

[Fisher]

Then she can just have Medicare as primary, and BCBS as secondary to avoid managed plan altogether.

BCBS is managed care. If she doesn't want to pay the BCBS premiums (even WITH the $800 giveback on Part B), look into suspending the FEHB and keeping the Humana PPO. Suspend, never terminate.

 

[somarco]

Look at the BCBS FEHB option for the STATE where your prospect lives. FEHB plans and options by state.

Also, her premium share is based on years of service . . .

And . . . she will most likely have to wait until open enrollment to make any changes.

 

[Patrick Flammia]

BCBS is managed care.

If she drops the Advantage Plan and keeps BCBS as secondary to original Medicare then it works just like a Medicare supplement, no?

 

[Fisher]

If she drops the Advantage Plan and keeps BCBS as secondary to original Medicare then it works just like a Medicare supplement, no?

Nope. She would still be subject to the BCBS network and deductible.

 

[Patrick Flammia]

Look at the BCBS FEHB option for the STATE where your prospect lives. FEHB plans and options by state.

There's only 2 options to choose from with Federal Retirees, basic and standard. Or am I missing something?

[EXTERNAL LINK] - Our Plans

 

[Patrick Flammia]

Nope. She would still be subject to the BCBS network and deductible.

This seems to contradict that? Says you get access to Medicare's network and can use FEP's if the doctor is not in Medicare's network.

To me it sounds identical to a Medicare supplement that includes drug coverage for $188 per month (basic option). Plus the $800 reimbursement so we'll call it $121 per month.

[EXTERNAL LINK] - Using Your Benefits

 

[somarco]

There's only 2 options to choose from with Federal Retirees, basic and standard. Or am I missing something?

[EXTERNAL LINK] - Our Plans

[EXTERNAL LINK] - Healthcare : Compare 2023 Plans - OPM.gov

 

[somarco]

access to Medicare's network

OM does not have networks, referrals, prior authorization . . .

 

[Fisher]

Has anyone ran into this before? Humana is paying first and BCBS picks up all of her copays. She likes it, but she's paying $300 per month for the BCBS.

She likes the extras from the MAPD. So I'm thinking of offering a PPO so she can at least get away from an HMO.

I'm not trying to argue with you, and it sounds like you are the one creating an issue where one may not even exist for this lady. Get all of your facts and details straight and put the options on the table for her. It is not your place to decide what is best for anyone. (There are exceptions to that statement, but this isn't one of them as far as I can see.)