Medicare + FEHB MOOP

[ValeRosso]

Anyone familiar with how this works if someone has A/B + FEHB?

Looking at the BCBS (guide), it lists all 3 options of BCBS (Blue focus, Basic, Standard) as having a MOOP (9k, 6.5k, 6k), but it also gives a list of medical services, and all show $0 responsibility for the member, and apparently Medicare + FEHB "acts like a med supp from what someone told me". If this is so, why does it have a max out of pocket? What other expenses will there be?

 

[somarco]

This may address some of your questions about COB with Medicare & FEHB . . .

Coordination of Medicare and FEHB Benefits

General information regarding the coordination of Medicare and FEHB benefits.

www.opm.gov

Unless things have changed, FEHB is a federal program where the benefits, premiums, etc vary by state (where you reside) and depending on the carrier you select.

Blue is not a national carrier so benefits and rates vary by state.

As for your OOP question, it varies . . .

If you have Medicare + FEHB and are retired, the FEHB is secondary to Medicare and mimics a Medigap plan so you don't need it + Medigap.

If you have Medicare A & B + FEHB you can have an MA plan which offers "extra benefits" and MAY pay your some or all of your Part B premium.

And SOME FEHB plans are also MA plans.

Simple, right?

 

[ValeRosso]

Thanks Somarco. Yes, extremely simple

The person is an annuitant, so retired, so looks like Medicare is primary. We were comparing Medicare + FEHB versus Medicare + Supplement.

Supplement route saves money on all options except for the minimum FEHB plan, which is about $40 a month cheaper than supplement route, but has network restrictions and a $500 deductible.

Plus the $2k MOOP on drugs with Medicare is an additional benefit.

 

[DonP]

Anyone familiar with how this works if someone has A/B + FEHB?

Looking at the BCBS (guide), it lists all 3 options of BCBS (Blue focus, Basic, Standard) as having a MOOP (9k, 6.5k, 6k), but it also gives a list of medical services, and all show $0 responsibility for the member, and apparently Medicare + FEHB "acts like a med supp from what someone told me". If this is so, why does it have a max out of pocket? What other expenses will there be?

I looked this last yr and I couldn’t beat the Fehb with a sup and part d plan as they had heavy drug cost . But you also have to take into account if having A and B they have no out of pocket how does that affect their rx cost ? Last yr when i compared they just came Fehb just came out with a jam up United healthcare mapd with a $1k moop and enchanced drug coverage .I’m betting many of those group mapd plans have no part d deductible and great formularies . I’ve always been wary of messing with big company retirement medical plans

 

[somarco]

$2k MOOP on drugs with Medicare is an additional benefit.

Part D only and drug(s) must be on the formulary . . .

 

[ValeRosso]

I looked this last yr and I couldn’t beat the Fehb with a sup and part d plan as they had heavy drug cost . But you also have to take into account if having A and B they have no out of pocket how does that affect their rx cost ? Last yr when i compared they just came Fehb just came out with a jam up United healthcare mapd with a $1k moop and enchanced drug coverage .I’m betting many of those group mapd plans have no part d deductible and great formularies . I’ve always been wary of messing with big company retirement medical plans

Yeah high drug cost could make it a wash. The drug MOOP are $3,250 or $2k for the highest plan (but the highest adds about $1560 extra premium per year) so for most probably not worth the extra premium.