FEHBP and Medicare Coordinating Coverage Tammy Flanagan Senior

FEHBP and Medicare Coordinating Coverage Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc.

1960 FEHBP ◦ Public Law 86 -382 ◦ Largest group insurance in world ◦ Covers 8 million enrollees ◦ 200+ choices ◦ Open Seasons ◦ OPM Oversight www. narfeny. org

1965 Medicare ◦ ◦ ◦ Public Law 89 -97 Health Insurance for Americans 65+ Only ½ seniors had health insurance A & B only Part B: $3/month 20 million original enrollees

1983 Medicare for Federal employees P. L. 97 -248 ◦ Tax Equity and Fiscal Responsibility Act of 1982 January 1, 1983 Who would benefit from this change?

Section 9 of FEHBP Plan Brochures The decision to enroll in Medicare is yours. We encourage you to apply for Medicare benefits 3 months before you turn age 65. It’s easy. Just call the Social Security Administration toll-free number 1 -800 -772 -1213 (TTY 1 -800 -325 -0778) to set up an appointment to apply. If you do not apply for one or more Parts of Medicare, you can still be covered under the FEHB Program.

Other Significant Dates 1988 1989 1997 2003 2006 2011 ◦ Medicare Catastrophic Coverage Act Repealed ◦ Balanced Budget Act of 1997 ◦ Medicare + Choice (Medicare Part C or Medicare Advantage) ◦ Medicare Prescription Drug, Improvement and Modernization Act ◦ Medicare Part D available ◦ Medicare Part B Pilot (FEHBP) www. narfeny. org

Medicare Part A – Hospital Insurance Inpatient or Outpatient? inpatient starting the day you’re formally admitted to the hospital with a doctor’s order. outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays. Part A Coverage

Medicare Part A- Hospital Insurance You pay (or FEHBP or Tricare For Life) (2012): Medicare and FEHBP Days 1 -60: $1, 156 deductible Days 61 - 90: $289 / day coinsurance Days 91+: $578 coinsurance (up to 60 days/lifetime) Beyond lifetime reserve days: all costs

Medicare Part A – Hospital Insurance Blue Cross and NALC (skilled nursing care): We pay the applicable Medicare Part A copayments incurred in full during the first through the 30 th day of confinement (skilled nursing care). $144. 50 x 10 = $1, 445. 00 Compass Rose is even better! Medicare (2012): Days 1 – 20: 100% coverage Days 21 – 100: covered all but $144. 50 / day After 100 days: no coverage

What about HMO’s? Kaiser Permanente Federal Employees ◦ 100 days in Kaiser facility with some co-pays Aetna aetna Federal Employees ◦ CDHP: 60 days of skilled care with a 20% coinsurance / in network and 40% coinsurance /out of network. ◦ HDHP: 60 days with 20% or 40% coinsurance ◦ Open Access: 90 -day limit -100% coverage M. D. IPA ◦ 60 days with no copay or coinsurance Care. First Blue. Choice ◦ No dollar or day limit if Plan doctor determines necessary

Medicare Part B – Doctors / Outpatient Coordinate with FEHB coverage for same services Some FEHB plans will waive deductibles, copays and coinsurance Medicare caters to the needs of elderly and disabled ◦ Durable Medical Equipment ◦ Therapy (physical, occupational, speech) ◦ Skilled Nursing Care

Cost Depends More expensive if AGI income greater than $85, 000 or $170, 000 $99. 90 (2012) for joint filers) Per person 2013 increase cannot exceed COLA (1. 7%) Medicare Website Monthly Premium Could be higher!

Medicare Part B with BC/BS Style FEHBP Plan – (FFS/PPO) Waive out-of-pocket Gain Medicare benefits Budget expenses Use any Medicare participating provider Part B premiums Higher income / higher premiums Good health / little benefit Enroll late / surcharge No waiver of prescription co-pays Advantages Disadvantages

Medicare Part B with HMO Gain Medicare benefits Part B premiums Budgets medical Higher income / higher expenses Good health / little benefit Use any Medicare Enroll late / premium participating provider premiums Move / lose coverage? Advantages surcharge No waiver of coinsurance or co-pays Disadvantages

Compare Benefits Medicare FEHBP (Kaiser)

Compare Benefits Medicare FEHBP – BC/BS

Compare FEHBP Plans First Click: 2013 “Health” Then, Click: Plan Information

Check Section 9 of FEHBP Brochure

Choose a less expensive FEHB Plan APWU High Option BC and BS Service Benefit Plan – Standard Option BC and BS Service Benefit Plan – Basic Option GEHA Benefit Plan – High Option GEHA Benefit Plan – Standard Option MHBP – Standard Option – Medicare Pilot Program MHBP – Value Plan NALC SAMBA – High Option SAMBA – Standard Option Self Family $132. 72 $186. 14 $300. 10 $433. 63 $127. 99 $299. 70 $197. 51 $97. 36 $209. 32 $468. 86 $221. 41 $504. 59 $93. 40 $160. 66 $248. 19 $131. 71 $222. 69 $326. 04 $637. 52 $300. 81

Choose a less expensive FEHB Plan Virginia Aetna Open Access – Basic (HMO) Virginia Aetna Open Access – High (HMO) Virginia Aetna Health. Fund – Value Virginia Kaiser Foundation Health Plan Mid-Atlantic States – High (HMO) Virginia Kaiser Foundation Health Plan Mid-Atlantic States – Standard – (HMO) Virginia Care. First Blue Choice - High (HMO) Virginia Care. First Blue Choice – Standard (HMO) Virginia M. D. IPA (HMO) Self Family $133. 79 $304. 25 $436. 06 $982. 17 $124. 38 $152. 81 $282. 43 $381. 76 $94. 45 $217. 24 $156. 08 $360. 62 $135. 27 $304. 32 $166. 96 $417. 79

Choose a less expensive FEHB Plan APWU CDHP GEHA HDHP MHBP – HDHP Virginia Aetna Health Fund – HDHP Virginia Aetna Health. Fund – CDHP Virginia Care. First Blue Choice – HDHP Compass Rose Health Plan (Restricted Plan) Foreign Service Benefit Plan (Restricted Plan) Rural Carrier Benefit Plan (Restricted Plan) Self Family $94. 58 $104. 96 $134. 40 $103. 76 $158. 71 $127. 44 $154. 57 $212. 77 $239. 74 $304. 55 $227. 22 $378. 69 $284. 25 $385. 19 $124. 11 $305. 79 $189. 73 $311. 37

When to Enroll? Medicare Enrollment Period Publication

Initial Enrollment Period

Special Enrollment Period

General Enrollment Period

Questions? 3 Medicare and You 2013 Publication