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FEHBP and Medicare:Make the BEST ChoiceA NARFE Federal Benefits Institute WebinarPresented by Tammy FlanaganNational Active and Retired Federal Employees AssociationSponsored by
MedicareOriginalMedicare:Part A—HospitalizationPart B—Doctorsservices, outpatientcarePart C—MedicareAdvantage PlansIncludes Part A and Part BPart D—Prescriptiondrug coverageNational Active and Retired Federal Employees Association2
FEHB Federal Employees Health Benefits Act of 1959 OPM has the authority to contract with insurers andprescribe regulations Employees & retirees access the same plans at the same cost 40 billion in health care benefits annually 8.2 million federal employees, retirees and their dependents About 85% of federal employees participate About 90% of retirees participateNational Active and Retired Federal Employees Association3
Test Your KnowledgeWhen did federalemployees begin payinginto Medicare?National Active and Retired Federal Employees AssociationA.B.C.D.41960196519832001Sponsored by
Test Your KnowledgeWhen did federalemployees begin payinginto Medicare?National Active and Retired Federal Employees AssociationA.B.C.D.51960196519832001Sponsored by
Did you know?You are not required to enroll inMedicare at age 65Your Federal Employees Health Benefits plan willcontinue to provide coverageNational Active and Retired Federal Employees Association6
Part A - The Easy Part!No premium, covered by 1.45% Hospital Insurance TaxIn general, Part A covers: Hospital care Skilled nursing facility care Nursing home care (as long as custodial care isn't the only careyou need) HospiceNational Active and Retired Federal Employees Association7
Part A - Hospital InsuranceMedicare paysFEHB paysDays 1 - 60All but 1,260deductible 1,260 deductibleDays 61 - 90All but 315 / day ofeach benefit period 315 / dayDays 91 and beyondAll but 630 / day upto 60 days per lifetime 630 / dayBeyond lifetimereserve days 0All CostsNational Active and Retired Federal Employees Association8
Excerpt from 2015 OPM CarrierCall LetterNewly Medicare-eligible federal retirees areenrolling in Medicare Part B in declining rates.Reasons:–Not enough incentives to enroll–OPM recommends: Reduced cost-sharing Improve coordination of pharmacy benefitsNational Active and Retired Federal Employees Association9
Advantages of enrolling inMedicare A & BCaution: Many of the advantages of enrolling inMedicare A & B are realized after Medicare isprimary payer.National Active and Retired Federal Employees Association10
Primary PayerReference Pamphlet:The Federal Employees Health Benefits Program and Medicare (RI 75-12)When you - or your coveredspouse - are age 65 or overand have Medicare and you Medicare FEHBHave FEHB coverage on your own as anactive employee or through your spouse whois an active employeeHave FEHB coverage on your own as anannuitant or through your spouse who is anannuitantNational Active and Retired Federal Employees Association11
When Medicare is primary. FEHB plans reap rewards by being secondary payer You will no longer need to use FEHB preferred providers You will no longer need precertification hospital stays Use any provider that accepts Medicare Providers are required by law to file claims– This is true whether or not they accept MedicareNational Active and Retired Federal Employees Association12
When Medicare is primary. Lower out-of-pocket cost for health care– Some FEHB plans will waive Deductibles Co-payments Coinsurance– Some FEHB plans will lower cost of prescriptionexpenses Medicare specializes in the needs of theelderly and disabled– Skilled nursing care– Durable medical equipment– Physical, occupational and speech therapyNational Active and Retired Federal Employees Association13
Medicare does not cover: Long-term care (also called custodial care) Most dental care Eye examinations related to prescribing glasses Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting them Routine foot careNational Active and Retired Federal Employees Association14
Some/all FEHB plans provide. Emergency care outside the United States Dental and Vision care (not all) Catastrophic coverage Prescription coverage Hearing aids (not all)National Active and Retired Federal Employees Association15
Latest on Medicare Part B2016 Part B premium 121.80 / month– “Hold Harmless” will remain 104.90– Higher income beneficiaries will be 121.80 (orhigher depending on your income).National Active and Retired Federal Employees Association16
Hold HarmlessNo COLA for Social Security benefit No increase in Part B PremiumThe provision protects only people who have Part Bpremiums withheld from their Social Security checksNational Active and Retired Federal Employees Association17
NARFE President Richard Thissenissued the following response:“NARFE has been sounding the alarm on this issue sinceJuly, and has been working continuously to urgeCongress to find a solution. This fix may not be perfect,but it is a major victory. I want to thank the thousands ofNARFE members who wrote or called their members ofCongress to push them to address this issue.”National Active and Retired Federal Employees Association18
YearPart B Premium1966 31976 7.201986 15.501996 42.502006 88.502007 93.50Higher premiums forhigh-income enrolleesHistoryofPart BPremiums 121.80 x 12 months 1,461.60 / year20132014 104.90Higher premiums forhigh-income enrollees20152016 1,461.60 x 2 people 2,923.20 104.90 or 121.80(OR MORE)National Active and Retired Federal Employees Association19
Nothing else increased 4,000%(except maybe a Parker Pen set)In 1966. Average Cost of new house: 14,200.00 ( 270,200 in 2015) Average Income per year: 6,900.00 ( 46,481.52 in 2014) Gas per Gallon: 32 cents ( 2.59 in 2015) Average Cost of a new car: 2,650.00 ( 31,252 in 2015) Dishwasher: 119.95 ( 500.00 in 2015) Parker Pen Set: 11.95 ( 414.95 in 2015)National Active and Retired Federal Employees Association20
If your yearly income in 2014 (for what you pay in2016) wasYou pay (in2016)File individual tax returnFile joint tax return 85,000 or less 170,000 or less 121.80above 85,000 up to 107,000above 170,000 up to 214,000 170.50above 107,000 up to 160,000above 214,000 up to 320,000 243.60above 160,000 up to 214,000above 320,000 up to 428,000 316.70above 214,000above 428,000 389.8021
Test Your KnowledgePercentage of nonpediatric primary carephysicians who acceptMedicare in the UnitedStatesNational Active and Retired Federal Employees AssociationA.B.C.D.2250%72%93%35%Sponsored by
Test Your KnowledgePercentage of nonpediatric primary carephysicians who acceptMedicare in the UnitedStatesNational Active and Retired Federal Employees AssociationA.B.C.D.2350%72%93%35%Sponsored by
National Active and Retired Federal Employees Association24
onal Active and Retired Federal Employees Association25
Enrolling in MedicareInitial Enrollment: 7 months beginning 3 months before you turn 65General Enrollment: January 1 - March 31 (coverage begins July 1)Special Enrollment: 8 months following end of employment that includedgroup health insurance coverageNational Active and Retired Federal Employees Association26
Enrolling in MedicareEnrollment is automatic for Medicare Part A and Part B ifyou are: Receiving benefits from Social Security or the Railroad Retirement Board Under age 65 and have a disability. Diagnosed with ALS (Amyotrophic Lateral Sclerosis, also called LouGehrig's disease). Living in Puerto Rico and get benefits fromSocial Security or the RRB.National Active and Retired Federal Employees Association27
Enrolling in Medicare Apply onlinewww.ssa.gov By phone1-800-772-1213 In person atany SocialSecurityoffice.National Active and Retired Federal Employees Association28
What Are The Options?Change FEHBplanLess expensive plans availableDelay Part BenrollmentIncur 10% surcharge for every12 months delayUse TRICAREfor LifeOnly available to military retireesand spousesUse MedicareAdvantagePlansMay incur higher out of pocketexpensesNational Active and Retired Federal Employees Association29
Cost of FEHB PlansSelf OnlySelf PlusOneSelfOnlySelf PlusOneAPWU HighOption 173.34 335.98GEHAStandard 112.21 241.25APWU CDHP 112.54 247.58GEHA HDHP 117.00 251.56BCBS /Standard 217.06 501.17MHBP ValuePlan 128.16 303.65BCBS / Basic 148.38 348.29MHBPStandard 151.63383.00GEHA HighOption 217.43 496.51MHBP HDHP 140.55 311.03National Active and Retired Federal Employees Association30
Cost of FEHB PlansSelfOnlySelf PlusOneSelfOnlyNALC High 157.19 351.60United Healthcareof CA High 158.10 302.90NALC CDHP 108.46 235.51United Healthcareof CA Standard 139.46 272.38NALC Value 93.38 202.79Kaiser MidAtlantic High 156.24 398.99SAMBA High 289.88 655.93Kaiser Mid-Atlantic 116.44 263.14StandardSAMBA Standard 137.45 302.40Aetna DirectNational Active and Retired Federal Employees Association31SelfPlusOne 118.33 259.50
How to choose? Consider a less expensive FEHB plan Compare cost of prescriptions Compare Medicare enrollment incentives Is there a health fund or do you have an HSA? Do you have any chronic illnesses? Do you need additional dental / vision plan?National Active and Retired Federal Employees Association32
UseTools toCompareHealth & InsuranceCOMPARE PLANS Find plans by location Find plans by nameOffice ofPersonnelManagement Find plans by plan codeEnter up to 4 thcare/plan-information/compare-plans/National Active and Retired Federal Employees Association33
UseTools toCompareChoose a Plan & EnrollFEHB Plan Information for 2016Office onal Active and Retired Federal Employees Association34
UseTools toCompareFEHB PlanBrochuresMedicare info:Section 9National Active and Retired Federal Employees Association35
UseTools toComparenarfeMagazineNational Active and Retired Federal Employees Association36
Age 65 and over without Medicare FEHB will limit payments for inpatient hospital care andphysician care to payments you would be entitled to if youhad Medicare. Your physician and hospital cannot bill you for more thanthey could bill you if you had Medicare. Outpatient hospital care and non-physician-based care arenot covered by this law; regular Plan benefits apply. More information: Section 9 FEHB Plan BrochureNational Active and Retired Federal Employees Association37
TRICARE for Life Must enroll in Medicare A & B May “Suspend” FEHB No need for Medicare Part D No need for Medicare Part C 1-800-538-9552 1-866-363-2883 (TDD/TTY) ional Active and Retired Federal Employees Association38
Low Income Benefits Medicare’s Low Income Benefits for people with limitedincome and resources Medicare prescription drug plan is available Information regarding this program is available through theSocial Security Administration National Association of Area Agencies on Aging:http://www.n4a.org/– State Health Insurance Assistance Program (SHIP)National Active and Retired Federal Employees Association39
To Do List Consider Self Plus One (for family of two) Report Medicare enrollment to FEHB and doctors Compare and consider all available FEHB plans Attend a local health fair if available Consider future health care costs Spend as much time on choosing health plan as you doplanning your next vacation!National Active and Retired Federal Employees Association40
Open SeasonNovember 9December 14National Active and Retired Federal Employees Association41Sponsored by
Sponsored byTo keep you and your eyes healthy,UnitedHealthcare Vision offers access to numerouseye doctors, affordable plan options and more.Find a plan that's right for you.www.myuhcvision.com/fedvip1.866.249.1999An American Company helping Americans live healthier livesNational Active and Retired Federal Employees Association42 Sponsored by
group health insurance coverage National Active and Retired Federal Employees Association . 27 Enrolling in Medicare Enrollment is automatic for Medicare Part A and Part B if you are: . SAMBA High 28
