Thanks for the info, it's very helpful. It is self-only. I did some more digging and it's a difficult decision. The Aetna plan description does mention the prescription drug costs if you opt out of the part D coverage (which I think my mother would do, due to IRMAA). For generics, the cost is similar or lower than BCBS Basic, but for the higher tiers, the costs are potentially much higher:Assuming you are speaking of a self only situation, the differences between Focus and Basic are small in my opinion. After the $800 reimbursement the true difference in premiums is about $50 per month. Everything else is about the same such as in-network requirement, no extra Skilled Nursing days, and how it works with Medicare. The Rx coverage is better in my opinion with Basic whether in the regular plan or the Part D option. The catastrophic limit if ever required is lower in Basic. One thing though: If a person were to ever "exhaust" their Part A hospital days (which can be done if in the hospital long enough) I believe Basic is better as the backup, with its set copay rather than the Focus 30% coinsurance. But that's my opinion.
I have the same questions re Basic vs Focus. My mother, who is in her 90s, is on BCBS Basic with Medicare part B. (I'm making medical and financial decisions on her behalf.) Next year, IRMAA will add $2,220 to her part B premiums. I'm reluctant to cancel part B because that's an irreversible decision and who knows that FEHB plans are going to look like going forward. She is a heavy user of health care services so Focus is probably not the right plan. It does save $1404 in premiums, but it also doesn't provide the $800 reimbursement for part B premiums, and it has the $500 deductible. Well, for someone who is almost certain to meet the deductible, that's $1300 more that a Focus member would have to pay than a Basic member, nearly offsetting the premum savings entirely. And if you add the $257 Medicare deductible, the cost of Focus is actually greater than that of Basic. So I am leaning towards biting the bullet and and sticking with Basic.
Aetna Direct looks like a decent alternative, but it looks like you have to get their version of a Medicare part D plan - which will incur IRMAA. Presumably there is some way to opt out (just like my mother did when BCBS tried to move her to their part D thing), but it's unclear what exactly the drug benefits are if you do. I don't think the savings from switching to AETNA would be great enough to offset the uncertainty. BSBS Basic + part B has been *fantastic*. In most years, literally all she pays (other than premiums) is <$200/year for prescription drugs. (She's lucky not to have ever been prescribed any expensive high-tier medications.) In addition, because she never gets a bill, I don't have any work to do (verifying the provider billed Medicare and the insurance company correctly, making sure it gets paid, etc). That alone is worth $1000 per year.
I personally do not see much if any advantage with the Basic Part D option over the regular Basic Rx, especially if IRMAA is involved, other than the $2000 Part D cap max out of pocket per year. I plugged in a few common meds and saw no difference, but there could be some.
As far as Aetna Direct vs BCBS Basic, the Aetna regular Rx has a copay of $6/mo for many meds, which is auto-deducted from the $900 reimbursement fund. I have found the Aetna Direct Part D Rx option better for us, and lower cost usually. Compared to Basic Rx, The Aetna Direct Part D option seems lower cost usually in my opinion, while I consider Basic to be lower cost than the regular Aetna Direct Rx plan.
With Aetna Direct, one wants to make sure providers accept Medicare "assignment" to work best (see Medicare.gov for who does so). Aetna Direct premium and reimbursement is a little better than Basic currently. Aetna Direct does give a total of 60 days of Skilled Nursing days (covers 40 more after the initial Medicare 20 days). Basic currently gives zero. Since the 2025 copay for Skilled Nursing through Medicare Part A is around $209 per day for days 21-100, if a person was in a SNF for 60 days in a year--not necessarily all at once--they could save about $8000 with those extra 40 days which Aetna Direct gives. This might not be a big deal to someone with sufficient funds to cover this even many times.
I consider Aetna Direct and BCBS Basic to both be outstanding plans. If you don't mind, please post what your final decision is and why as it might possibly help others.
BCBS Basic member costs:
Tier 1 (Generics): $10 copay
Tier 2 (Preferred brand): $50 copay
Tier 3 (Non-preferred brand): 50% of our allowance ($60 min)
Tier 4 (Preferred specialty): $80 copay
Tier 5 (Non-preferred specialty): $100 copay
Aetna Direct member costs:
Tier 1 Preferred Generic: $6
Tier 2 Preferred Brand: 30% up to $600
Tier 3 Non-preferred Generic or Brand: 50% up to $600
Tier 4 Preferred Specialty: 50% up to $600
Tier 5 Non-preferred Specialty: 50% up to $1,200
The Aetna costs are listed on the website as being lower if you use CVS (the percents are the same but the "up to" values are $100 or $200), but that's not explicitly mentioned in the detailed plan description.
The two other relevant differences (as far as I can tell) are: 1. BCBS Basic covers preventive/diagnostic dental with $35 copay, whereas Aetna does not; and 2. Aetna covers an extra 40 days of skilled nursing facility (SNF) stays, whereas BCBS basic does not. Dental insurance costs roughly $360/year, which would eat into the savings from switching to Aetna Direct, but would also provide coverage for fillings etc. My mother has been in a SNF twice in the last few years, once for a bit longer than the Medicare 20 day free period, whereas she has never been prescribed medications higher than tier 1. So based on history, it would seem that the Aetna plan would make more sense - but of course you never know what fate has in store.
I *think* we will roll the dice and switch to Aetna for the $682 annual savings (roughly $950 premium savings + $100 more Medicare premium reimbursement - $360 dental plan premium) which would include better dental coverage, SNF coverage, but possibly higher medications pricing. If she does end up getting prescribed expensive medications, well, it's for at most 1 year and then we can switch again.
Statistics: Posted by snic — Mon Dec 02, 2024 6:04 am — Replies 84 — Views 5659