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As a Fed retiree, I use Medicare parts A&B with FEHB BCBS Std As my secondary. (My wife is also covered).
As a Type 1 diabetic with an insulin pump & (Dexcom) CGM I go thru a lot of supplies regularly, Medicare Pt B pays 80% of the costs, and BCBS picks up the remaing 20%.
I pay zero copay for insulin or infusion sets.
I know that Pt. B is a godsend for insulin-dependent diabetics, not sure if I would need it otherwise. Also, thanks to BCBS I rarely pay DR copays, and my Rx’s are usually very low.
Thanks for the reply. I'm glad everything is covered for you, it's not for me. If the Diabetic doesn't have the pump for whatever the reason. All that is covered is the Glucose strips and they are at a limited amount. Believe me I asked and that's how it was explained by Medicare.
Yes there is a difference in price for a prescription between the Standard and Basic BCBS Plans. I'm not sure how much. I just knew the monthly premium for the policy is quite abit more for Standard. So I always had the Basic. It's just now the insulin cost in this country is way out of control. So much so it's been addressed in congress. As it has for anyone that has to use an Epipen. That's another group of people really hit hard by the cost of prescriptions. It's really a shame the outrageous cost of healthcare has never been taken care of in this country. I doubt it ever will be in my lifetime.
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.
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 there is a difference in price for a prescription between the Standard and Basic BCBS Plans. I'm not sure how much. I just knew the monthly premium for the policy is quite abit more for Standard. So I always had the Basic. It's just now the insulin cost in this country is way out of control. So much so it's been addressed in congress. As it has for anyone that has to use an Epipen. That's another group of people really hit hard by the cost of prescriptions. It's really a shame the outrageous cost of healthcare has never been taken care of in this country. I doubt it ever will be in my lifetime.
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 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.
Bad advice. You'll waste a lot of $ since BCBS was not designed for retirees.
You need to look at Aetna Direct. Equal to or better than BCBS Standard in all ways, and much less expensive, IF the insured are on Medicare A&B. If you are, all the deductibles, co-pays and network limitations go away, and you get a health fund to use for prescription co-pays or Medicare Part B premiums. IOW cash back...
Thanks for the reply. I'm glad everything is covered for you, it's not for me. If the Diabetic doesn't have the pump for whatever the reason. All that is covered is the Glucose strips and they are at a limited amount. Believe me I asked and that's how it was explained by Medicare.
JimRob1. You havent mentioned if you are Type 1 or Type 2.
Medicare covers Type 1 diabetics differently than Type 2’s. The test they use is called a C-Peptide test.
(It determines how useful your pancreas is. Mine is worthless, therefore I’m a Type 1).
For T1 diabetics, Part B covers insulin and pumps + all supplies including Continuous Glucose Monitors.
If you haven’t done so, I would recommend you see an endocrinologist and hopefully get a C-Peptide test.
(Or if its been a while since youve had one done, since results can change over time).
Bad advice. You'll waste a lot of $ since BCBS was not designed for retirees.
You need to look at Aetna Direct. Equal to or better than BCBS Standard in all ways, and much less expensive, IF the insured are on Medicare A&B. If you are, all the deductibles, co-pays and network limitations go away, and you get a health fund to use for prescription co-pays or Medicare Part B premiums. IOW cash back...
Apologies, as I was piggybacking on another comment here encouraging him to review the standard plan. Indeed, FEHB has many plans - and I am in no way familiar with all the nuances of the many FEHB Plans - which is a world until itself. You, on the other hand are very knowledgeable on FEHB plans as I have observed over the years, so clearly jimrob needs to follow your advice.
Question - would he be better off dropping Medicare Part B and enrolling in a different FEHB plan? The question of the value of enrollment in Medicare Part B for govt retirees is asked here all the time.
Apologies, as I was piggybacking on another comment here encouraging him to review the standard plan. Indeed, FEHB has many plans - and I am in no way familiar with all the nuances of the many FEHB Plans - which is a world until itself. You, on the other hand are very knowledgeable on FEHB plans as I have observed over the years, so clearly jimrob needs to follow your advice.
Question - would he be better off dropping Medicare Part B and enrolling in a different FEHB plan? The question of the value of enrollment in Medicare Part B for govt retirees is asked here all the time.
It's interesting that Consumer's Checkbook annual guide to Federal health plans discusses (and models financially) exactly this question, and has concluded that for some plans, for some people, the answer is yes.
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.
JimRob1. You havent mentioned if you are Type 1 or Type 2.
Medicare covers Type 1 diabetics differently than Type 2’s. The test they use is called a C-Peptide test.
(It determines how useful your pancreas is. Mine is worthless, therefore I’m a Type 1).
For T1 diabetics, Part B covers insulin and pumps + all supplies including Continuous Glucose Monitors.
If you haven’t done so, I would recommend you see an endocrinologist and hopefully get a C-Peptide test.
(Or if its been a while since youve had one done, since results can change over time).
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.
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