LeventeGyori/Shutterstock.com

Getting the Best Health Plan Deal: An Experiment

What happened to five people who changed their coverage in 2015.

As I’ve noted in recent columns, open season for the Federal Employees Health Benefits Program provides an opportunity to consider switching plans and potentially saving some money. Before this year’s open season ends on Monday, I wanted to provide an update on the non-scientific experimentI conducted with five friends this year. They switched from the Blue Cross Blue Shield Standard Option to the new Aetna Direct high deductible health plan during last year’s open season. This plan was new for 2015 and was designed to work with retirees who are enrolled in Medicare parts A & B.

Three of my friends who made the switch -- Ellie, Sharon and Edie -- are widows in good health who range in age from 72 to over 90. All three of them have decided to stay in Aetna Direct, which, with a self-only enrollment, provides a health fund of $750 a year for out of pocket expenses. (Self plus one or self and family enrollments provide bigger funds.) Ellie, Sharon and Edie all will carry unused health fund dollars into 2016. The self only monthly premium for 2016 is $118.33.

For my two other friends, Wanda and Cliff, deciding whether to remain in Aetna Direct or go back to Blue Cross Blue Shield was a more difficult call. Because they needed expensive non-generic drugs, their health fund dollars were quickly exhausted. After the health fund was used up, they had to pay 100 percent of allowable charges until they met the deductible. (Deductibles for 2016 are $1,500 for self only, and $3,000 for self plus one or self and family enrollment.)

Nevertheless, Wanda and Cliff believe they’ve saved money by using Aetna Direct, because premiums are lower. So they’ve decided to remain covered for 2016. The self plus one premium will be $259 per month, compared to $501 for the Blue Cross Blue Shield standard option. So Wanda and Cliff will save $2,900 a year in premiums. Add in a $1,500 health fund, and they have a $4,400 head start before Aetna Direct will start costing more than Blue Cross Blue Shield.

According the the Consumers’ Checkbook Guide to Health Plans for Federal Employees and Abbuitants, other options for retirees who have Medicare A & B as their primary insurance include MHBP HDHP, APWU CDHP, GEHA Standard Option, NALC CDHP, NALC High Option, SAMBA Standard Option, and Blue Cross Basic Option.

One cautionary note: Retirees who have Medicare as their primary insurance must be sure to find doctors and providers who accept Medicare assignment -- that is, they accept the Medicare-approved payment amount as full payment. You can use Medicare’s tool to find doctors who are participating in Medicare and who accept assignment.

I received an email from a retiree who lives in Arizona and uses a Mayo Clinic facility located in the area. Although this facility provides medical services to Medicare patients, it doesn't accept assignment from Medicare for professional and physician services. It follows an established fee schedule based on the federal guidelines for Medicare patients, which allows health care organizations to charge up to 15 percent above the Medicare allowable fee. The patient is  responsible for the portion above the Medicare allowable amount.

Candice Sanchez, director of strategic planning for Aetna federal plans, said this is an “extremely rare situation,” and noted that a recent Kaiser Foundation study found that 96 percent of providers in the U.S. participate with Medicare, meaning they accept Medicare assignment. Other Mayo Clinic locations, she pointed out, are in Aetna’s network.

This just goes to show how important it is to explore all of your options in detail. That includes looking at plans available in specific areas or offered to specific groups, such as foreign service officers or rural letter carriers.

At the very least, if you’re a family of two, be sure to downgrade from self and family coverage to the new self plus one category before open season is over.

Correction: The original version of this column should have indicated that for prescription drugs and medications, Aetna Direct waives the deductible if the insured person is enrolled in Medicare parts A and B and Medicare is the primary insurer. The column has been updated to correct the error. 

(Image via LeventeGyori/Shutterstock.com)

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.