Personal Finance (Not Investing) • Federal Retiree - Medicare, Part A only?

I would really like to understand the provider choices as it applies to the part B decision.

1) Checkbook says:

Expanded Access to Doctors—If you join Part B, you can use the Part B benefit to go outside the FEHB plan provider network. If you decide to do this, you might have to pay the annual Part B deductible of $257 and 20% of the Medicare allowed charge for the service. For any BCBS members, this added out-of-network flexibility strengthens the case of considering Blue Cross Basic compared to Blue Cross Standard. One of the biggest differences between BCBS Standard and Basic is the out-of-network provider benefit available in the Standard plan. Without Part B, you receive no insurance benefit from going out-of-network if you're enrolled in BCBS Basic. With Part B, you can see any provider that accepts Medicare, using the Part B benefit.

Got it - if I have part B then I could use a doctor that accepts Medicare but not my FEHB plan. It might cost me more (20%), but I can do it. It is still unclear to me if I would always be paying the 20% Medicare coinsurance? I think the answer is yes. This seems more beneficial if you have a HMO plan vs PPO? Do some plans cover the 20% while others don't?

2) All of the FEHB plan brochures have a Section 9 that describe how the plan interacts with Medicare. The section titled, "When you are age 65 or over and do not have Medicare." It is super confusing. I think Checkbook summarizes it like this - note that it is under article titled, "Reasons Why You Shouldn't Enroll in Medicare Part B"

Provider cost—Once you reach age 65, a special rule applies whether you enroll in Medicare Part B or not. It is illegal for doctors who have not opted out entirely from Medicare to charge patients covered by Medicare more than a limiting charge. This restriction applies to all FEHB retirees over age 65, whether they have Medicare or not. Under this provision, you will not be exposed to high charges that neither Medicare nor your FEHB plan recognizes as reasonable. You do not have to sign up for Medicare Part B to get this guarantee. Therefore, unlike employees, if you are over 65 you can use non-preferred providers without fear of being charged substantially more than the plan will recognize as reasonable. You must, of course, pay higher deductibles and coinsurance if the provider is not in your plans network.

I'm trying to ELI5 that statement, because it is worse in the brochures. If I go see a doctor that takes Medicare (in plan or not), then there are some capped charges.

Thoughts?

Statistics: Posted by clobber88 — Wed Sep 10, 2025 11:43 am — Replies 36 — Views 2601

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