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You need to look into BCBS Standard. People often ask here why not just go on Medicare plus a supplement rather than enroll in the retiree plan. From reports we've had here over the years in most cases, retiree plans are not limited to "if Medicare pays, then so will we." The typical private supplement will only pay its share if the service is covered under Medicare. Otoh, generally, a good retiree supplement plan will pay what Medicare doesn't in a wide range of medical services and medications. In other words, whether or not the medical the expense is covered under Medicare is not determinative.
Yes I think I will have to look into Standard and compare.
Because you have predictable, regularly occurring prescription costs every month, you might want to compare the monthly sum of your out of pocket meds and supplies to the difference between Basic and Standard premiums. You may think you're saving $ by sticking to the Basic level but you might more than make up the difference because of higher co-pays/supply costs. Can't predict as I don't know what your co pays add up to now, and maybe you've already done this, but it might be worth doing the math. Supply costs increase at some rate over time. Premiums do too, but maybe the rate is slower. At some point Standard might become the better option.
You may be sarcastic in your reply, or not. But do know that I've spent a lot of time wading through the full plan descriptions for a number of plans, as well as using the guide I already mentioned. There are a lot of plans that are bad for retirees compared to the best. Some fail because they don't waive co-pays etc. for those on Medicare. Others fail because of atrocious prescription drug benefits. Many are just plain expensive, to the point that I can't imagine anyone actually subscribing to them.
I've used Aetna Direct for over 4 years now in retirement. I've had several hospitalizations in two different states, expensive therapy, ongoing high drug expenses, diabetes treatment etc. Seems the only thing I haven't had is mental health or PT. Haven't had any out of pocket expenses. Even my drug co-pays have been covered by the health fund. It's cheaper than BCBS basic (with much better benefits) and over $200/mo cheaper for self plus one than BCBS Standard. The plans are underwritten state by state, but the coverage for Medicare retirees is national.
I've just repped you on this. My earlier comment was sincere. Zero sarcasm intended. Thank you for sharing your knowledge
Quote:
Originally Posted by Jimrob1
Yes I think I will have to look into Standard and compare.
As noted above, Aetna Direct is also worth investigating.
Also, have you considered visiting an FEHB forum on this issue? A search turned up these:
I'm a Type I. I have had the C-Peptide test and another test sometime ago that determined what I was. I take Novolog and Lantus Insulin. I've been a Diabetic for decades now. I could be on the pump but declined it for a variety of reasons. The pump isn't for everyone. Medicare says I am not eligible for insulin thru them. Whether its a mistake and I have fallen thru the cracks I don't know. It is possible to get people on the phone with Medicare or other businesses, that give out the wrong information. I got tired of asking Medicare and quite frankly the gov't period for help on this. I can get Insulin thru the VA but the restrictions would set one crazy. I believe I would have to go back on vials to get it thru them, as I'm a Veteran but not a service connected Vet. So they would not let me have the pens. Insulin thru the VA is only $24 for 3 months of Insulin. The other supplies are all at no charge. I may end up getting it thru the VA as I'm fed up with CVS Caremark thru BCBS. My other problem with the VA is I may be over income to get anything from them. As I fall under the needs a Means Test for treatment. There income restrictions are very very low. Many Veterans not service connected will not get care, or if they do will pay more than on the outside.
I waited 40 years as a T1D before i got a pump. Finally got tired of sticking myself.
My Rx for pump/ insulin , Dexcom and monthly supplies says “for use with Insulin pumpâ€, and it includes the Diag code for T1D. All are covered (Part B= 80%; supplemental/Secondary= 20%).
As of 2021, Medicare requires the rx to state these things. They also require quarterly doc visits (preferrably an Endo).
Each quarter, I go through 14 vials of insulin and lots of pump/CGM infusion sets etc. its all fully covered, once you jump thru the hoops.
I understand the pump isnt for everyone, but its saved my life a few times over the last couple years.
I think the reason Aetna Direct is not used more is because it's categorized by FEHB as a PPO, not as a national plan like BCBS. It is a high deductible PPO for those that are not on Medicare, and you must enroll in a plan for your state. But once you start Medicare, all the network restrictions disappear, as well as deductibles, co-pays and co-insurance. Insurance folks use the term "wrap around coverage" just like BCBS, but at lower cost.
Keep in mind that BCBS plans around the country were once non-profits, but no longer are (there could be exceptions - IDK). All that I'm aware of converted to for-profit status over the past 20 years or so, and rely heavily on their "brand equity".
Disclaimer: I am not diabetic. However, I am also a retired fed and chose Medicare A&B as the primary, plus BCBS Standard. Don't have many prescriptions, but so far the copays have been extremely low. Suspect the major difference here is between BCBS Standard and Basic coverage.
Same here, though between me and my husband, we do have a number of prescriptions. They're all generic, Tier 1 meds though, as far as I can tell, and the copays we pay for either 30 day, or 90 day prescriptions, no matter how many pills that comes to, is $3.00. Though I do have one generic eyedrop prescription for glaucoma that's around $10.00 for about a 5-6 week supply ( depending on how often I miss my eyes and get the drops on my cheeks).
I'm guessing the copays if we had the Basic BCBS would be considerably more.
Same here, though between me and my husband, we do have a number of prescriptions. They're all generic, Tier 1 meds though, as far as I can tell, and the copays we pay for either 30 day, or 90 day prescriptions, no matter how many pills that comes to, is $3.00. Though I do have one generic eyedrop prescription for glaucoma that's around $10.00 for about a 5-6 week supply ( depending on how often I miss my eyes and get the drops on my cheeks).
I'm guessing the copays if we had the Basic BCBS would be considerably more.
I haven't checked the various tiers but the copays run $10/30 day supply for tier 1 drugs with basic so not outrageous, at least for me.
I haven't checked the various tiers but the copays run $10/30 day supply for tier 1 drugs with basic so not outrageous, at least for me.
That isn't bad at all. Especially if that $10.00 copay also applies to a 90 day prescription of the same drugs. That's the case with the Standard Option Tier 1 drugs, ie, same copay for a 30 and 90 day supply.
Makes me want to look into the differences between the Basic and Standard options BCBS as secondary insurance with Medicare. The Standard Option is great ( no out of pocket expenses except for drug copays) but it's pricey. Next thing would be convincing my husband to switch, he thinks we need the Standard Option.
That isn't bad at all. Especially if that $10.00 copay also applies to a 90 day prescription of the same drugs. That's the case with the Standard Option Tier 1 drugs, ie, same copay for a 30 and 90 day supply.
Makes me want to look into the differences between the Basic and Standard options BCBS as secondary insurance with Medicare. The Standard Option is great ( no out of pocket expenses except for drug copays) but it's pricey. Next thing would be convincing my husband to switch, he thinks we need the Standard Option.
no, it's $10/30 days so a 90ds is $30. still not outrageous. YMMV
also, as i mentioned I have not looked at other tiers because I don't use anything currently not in tier 1
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My earlier comment was sincere. Zero sarcasm intended. Thank you for sharing your knowledge
