Chat Transcript: November 19, 2020
Chat Transcript
This is a transcript of an online chat and has not been edited for spelling or grammar. If you have a question that is not answered here or need more clarification, please contact NARFE’s Federal Benefits experts at fedbenefits@narfe.org
Question: So IRMAA is calculated from 2018 taxes, not 2019? Seems like they should have 2019 data.
Answer: 2021 Medicare premiums are based on 2019 tax returns
Question: I am a retiree and have BCBS Basic. I turn 65 next year. If I do not sign up for Medicare Part B, it appears that there are consequences with BCBS in that they will limit the amounts they pay for health care and I would be held responsible for the portion that Medicare Part B would have paid. Is this correct?
Answer: All FEHB plans are required to limit their payments based on the Medicare fee schedule allowance. This could actually reduce your out-of-pocket expenses. Check the plan brochure Section 9 for additional information about this. BCBS has some webinars that they’ve presented that you may be able to find through its website. If you contact fedbenefits@narfe.org we may be able to help you find more info on this question. The biggest concern with BCBS Basic and no Medicare Part B is the cost of out-of-network providers.
Question: You mentioned BCBS Basic as a good choice for retired people who will be traveling abroad. Are there any other good choices for travelers, specifically, are any of the Medicare Advantage plans good for travelers?
Answer: All of the plans will cover emergency care while traveling abroad. Some plans, such as BCBS, have offices overseas and don’t require you to have your bills translated or the amounts converted to US currency.
Question: When I can project that my income will be above $88K for the coming year, can I suspend my Medicare coverage until my income comes back down?
Answer: Although it is possible “disenroll” in Medicare Part B, it isn’t easy to do. https://faq.ssa.gov/en-us/Topic/article/KA-02713 You can voluntarily terminate your Medicare Part B (medical insurance). However, since this is a serious decision, you may need to have a personal interview. A Social Security representative will help you complete Form CMS 1763.
Question: If Medicare combined with FEHB is such a good combination after you retire, I don’t understand why you are saying that it doesn’t make sense to sign up for Medicare when you turn 65 yet are still working?
Answer: Because you wouldn’t get any benefit from it. If you’re still working, your FEHB plan is primary and Medicare doesn’t pick up your copays. When you retire, Medicare is primary.
Question: Do annuitants use Benefeds for additonal Dental and Vison insurance or OPM website?
Answer: BENEFEDS
Question: How do I obtain a paper copy of FEHB service benefit plan brochures?
Answer: Call the plan.
Question: Does NALC have a Medicare reimbursement for 2021?
Answer: CDHP and Value do, High does not
Question: What is the best GEHA policy for a healthy couple, one on Medicare Parts A & B, the other not on Medicare?
Answer: Check out this chart that compares all five of the GEHA Plan options: https://www.geha.com/plans/medical/medicare.
Question: Why is the BCBS Standard premium for couples much higher than other plans of that type?
Answer: Costs are based on the demographics of those enrolled in the plan.
Question: When does Medicare Open Season end?
Answer: Depends on which Medicare Open Season you are referring to. General enrollment for Medicare A & B is January – March. Part C Open Season (and Part D) is going on right now and will end December 7, and FEHB (and FEHB Medicare Advantage Plans) Open Season ends on December 14.
Question: Is it necessary to purchase extra dental/vision if the FEHB plan has it as part of its coverage?
Answer: Depends on your dental needs.
Question: You discussed the GEHA High plan, but not GEHA Standard. What are the disadvantages of GEHA Standard, compared to BCBS Basic and GEHA High?
Answer: GEHA Standard does not provide a reimbursement for Medicare Part B and it has a less generous prescription drug benefit if you need to use name brand or non-formulary. If you are enjoying relatively good health the Standard Option can still be an excellent choice for you and it does provide “wrap around” coverage with Medicare Parts A & B. https://www.geha.com/plans/medical/medicare
Question: What does GEHA pay if you do not have Medicare Part B?
Answer: Here is a comparison of the five GEHA Plans: https://www.geha.com/~/media93/Project/GEHA/GEHA/documents-files/medical/2021/2021-geha-medical-plan-comparison.pdf
Question: Does Aetna Direct cover specialty drugs? The chart didn’t say.
Answer: Here is the link to access their formulary: https://www.aetnafeds.com/pdf/2021/2021_Advanced_Control_Plan_Aetna_Federal_Employees.pdf
Question: Please provide the link to Checkbook.
Answer: https://www.checkbook.org/newhig2/hig.cfm
Question: I went to the NARFE website and could not find the link to plans that work best with Medicare. Help
Answer: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841about halfway down the page
Question: How does an annuitant suspend their FEHB coverage?
Answer: https://www.opm.gov/forms/pdf_fill/ri79-9.pdf Health Benefits Cancellation/Suspension Confirmation Form
Question: Where exactly on the opm website do you change your plan? I’m in my account but don’t see that option.
Answer: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/enroll/#annuitants
Question: If deciding to not take Part B because IRMAA makes it too expensive, is there a risk FEHB ever gets destroyed or eliminated by congress? And if that happens, is it likely premium penalties will be waived by those effected?
Answer: I don’t think that’s likely.
Question: I have BCBS and will enroll in Medicare Part A & B when I turn 65 next year. Is reimbursement by BCBS automatic or do I need to fill out form?
Answer: I don’t think the reimbursement with BCBS Basic is automatic. I believe there are procedures they have in place that you will follow for the reimbursement. I recommend calling a BCBS service rep for those details: https://www.fepblue.org/our-plans/basic-at-glance
Question: Where is the information about the restricted plans, specifically Compass Rose?
Answer: I would visit the individual plan’s website.
Question: How do I find out exactly which Kaiser plans cover me in my small Washington town?
Answer: I’d visit the Kaiser webpage.
Question: Does the Medicare Part B Premium change if your income changes each year?
Answer: If it’s enough to subject you to IRMAA, yes.
Question: Do I need to enroll in “family” coverage, versus “self plus one” to obtain coverage in retirement for my wife?
Answer: If it’s just you and your wife, Self Plus One.
Question: If I have Medicare will I have to pay copay to BCBS?
Answer: If Medicare is primary and you have Standard Option BCBS, your copays and coinsurance (and deductibles) are waived. Same is true for Basic if you used BCBS preferred providers.
Question: Several years ago at retirement, I was told that if you have BCBS and opt out of it, you would not be allowed back in. Is that still the case?
Answer: If you CANCEL your FEHB coverage regardless of your plan, then yes, that’s true. You cannot get it back if you cancel it in retirement.
Question: Can you have Medicare part B premiums deducted from your pension directly or do you have to pay in a different manner.
Answer: If you get Social Security benefits, your Medicare Part B premium will get deducted automatically from your benefit payment. Otherwise you may receive a bill that you can mail in a check for payment, or pay it online through your bank or through your Medicare Secure Account.
Question: I will be covered by Medicare Parts A & B next month. I will still be a current federal employee. I have BlueCross BlueShield Standard Option. Should, I change my plan to Basic or Focus?
Answer: If you’re still working there’s no benefit to signing up for Medicare part B
Question: What is a health reimbursement account and can retirees have one?
Answer: In general, a post-65 retiree-only HRA is structured to reimburse retirees for individual Medicare supplemental coverage premiums or individual Medicare Advantage coverage premiums. In some cases, a post-65 retiree-only HRA will also reimburse other premiums, such as dental and vision, as well as medical expenses.
Question: I’m a retired federal employee. My husband and I have Medicare Parts A & B. My husband has secondary insurance through his retirement. I have him covered under my GEHA Standard option (his tertiary). His Mobil Oil insurance is converting to an AETNA Medicare Advantage.
Answer: Interesting. He may wish to just use his Mobil Oil plan if he is confident that it will cover him for life. Maybe try this for a year without being under your FEHB plan and if he doesn’t like it, switch back to Self Plus One with you? Can he cancel his coverage with Mobil and just use FEHB with you? Check the costs, security, and flexibility of all options.
Question: What is IRMAA?
Answer: Income Related Monthly Adjustment Amount. The standard Medicare Part B premium amount in 2021 is $148.50. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
Question: It is my understanding that specialty drugs are not included in the catastrophic cap. Is this true?
Answer: It depends on the plan. In the HDHP (high deductible) plans, prescription costs are generally included. Be sure to read Section 4 of your plan brochure to review the Catastrophic coverage of your plan.
Question: If you are not in Medicare B, do you have to wait until you retire to enroll?
Answer: It doesn’t make sense to enroll if you’re still working.
Question: I have less than a year left before I retire. Would you recommend that I enroll in Medicare Part B now?
Answer: It doesn’t make sense to enroll in Medicare until you retire
Question: Please define a catastrophic cap.
Answer: It is the most you would pay out-of-pocket for eligible coinsurance and copayments amounts. It is usually different when using network vs non-network providers. Some plans will not cover non-network providers. There are often expenses you may have to pay that also aren’t included in this limit. Check Section 4 of your FEHB Plan brochure for more info.
Question: What do you think about going into an Advantage plan and then possibly getting out of it next year?
Answer: It would be a good way to test drive the plan. You may decide to continue the coverage or you may decide that it isn’t for you! Sometimes the only way to tell is to give it a try. Be sure to let your providers know that you have both in and out-of-network benefits with most of the Advantage plans under FEHB.
Question: What about long term health care coverage and Medicare Parts A & B plus FEHB?
Answer: Long-term care insurance comes into plan once you need non-skilled or personal care. You would still need to maintain Medicare A & B along with FEHB in addition to using long term care insurance benefits that would cover things like providing assistance with dressing, bathing, feeding and toileting or help cover the expense of room and board in an assisted living or nursing home. You can also receive care in your home with LTC Comprehensive plans. Your health insurance/Medicare will cover your acute care needs and preventative health care expenses.
Question: What amount is used in calculating Medicare Part B payments: Total Income, Adjusted Gross Income, or Taxable Income?
Answer: Modified Adjusted Gross Income (MAGI)
Question: My FEHB Plan is Carefirst BCBS (Washington DC) but I live in Northern Virginia. If I look for other plans available to me, do I look for Washington DC or Virginia?
Answer: Most of the regional plans that cover Washington also cover Northern Virginia and Maryland. The charts we have created for you have that information. You can access the charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading.
Question: Any advice on how to determine prices for specific drugs when using plan websites? We are not sure which “tier” our medications fall under.
Answer: Most plans have a formulary section for you to figure out drugs costs. I suggest using the charts that NARFE created for you. Each plan has a link to their formulary coverage and many include specific drug names. You can access the charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading.
Question: I want to look up the costs for the specific drugs that my husband and I take. How can I compare the the different FEHB plans?
Answer: NARFE compiled the following lists to help you make a more informed decision about your FEHB and Medicare coverage including Medicare reimbursements during the 2020 federal benefits Open Season. You can access the charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading. Find your plan on the charts and click on the link to their formulary.
Question: Where do I find information on the Advantage Plans?
Answer: NARFE compiled the following lists to help you make a more informed decision about your FEHB and Medicare coverage including Medicare reimbursements during the 2020 federal benefits Open Season. You can access the charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading. Look for the links to the regional plans. The enrollment code is linked to the plan brochure.
Question: Do the NARFE resource page and Checkbook compare FEDVIP plans?
Answer: NARFE has the FEDVIP facts, but the Checkbook will help you compare plans. You can also do that at benefeds.com.
Question: I understand that Medicare Advantage plans are county-specific. Where do I find if my county has such a plan?
Answer: NARFE put together charts that can help. You can access the regional charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading.
Question: If you are going to sign up for Medicare Part B but are not eligible for Social Security, what is the Hold Harmless cost for 2021?
Answer: No difference in 2021.
Question: Does Aetna Direct pay $300/month per couple for Medicare Part B?
Answer: No, it is $75/month per person or $150/month per couple.
Question: I have been retired for 2 years. I’d like to look at the Kaiser Permanente plan. Is that nationwide?
Answer: No, Kaiser is regional.
Question: Were higher IRMAA rates partly designed to discourage higher income seniors from applying for Medicare coverage?
Answer: No, not at all. Even the highest IRMAA only covers 80% of the actual MedicarePart B premium. It was requiring those who Congress felt could afford to pay more of the premium to pay a higher percentage of the cost, a form of “means testing.” Luckily, there is no such means testing with FEHB premiums, the federal government still contributes on average 72% of the premium cost regardless of your income.
Question: Is it possible to request a paper copy of OPM’s plan comparison guide from OPM?
Answer: Not OPM’s.
Question: Does Aetna Medicare Advantage plan have a donut hole in prescription coverage?
Answer: Not the FEHB Aetna Medicare Advantage Plan. The Medicare Part C plans available on medicare.gov that are not part of FEHB are different.
Question: Will a session be held on FEHB Dental and Vision plans?
Answer: Not this year, but we’ve already started planning for it next year. Feel free to reach out to our experts if you have questions about your vision and dental coverage – fedbenefits@narfe.org.
Question: Which plans provide the largest Medicare Part B reimbursement?
Answer: On the NARFE Open Season webpage (https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841) you can see all the plans with Medicare reimbursement. It’s about halfway down the page.
Question: Where do I find the earlier seminar on Medicare Advantage plans?
Answer: Once logged into the NARFE website, click webinars down the page on the left. It’s the one from Oct. 2020
Question: How do you find out the most popular or widely used plan in a particular state?
Answer: OPM has statistics on this. If you can find OPM’s Statistical Year Abstracts, you will see the plans available and how many are enrolled. I can send this to you, but I can’t find it right now to provide a link. Email Tammy@retirefederal.com.
Question: I recently retired. Where do I actually go to make my insurance choice?
Answer: OPM’s website
Question: Can I change from BCBS Basic to an Advantage Plan when I retire outside of the open period?
Answer: Other than a regular qualifying life event (such as loss of family member, addition of family member, relocating to an area where the current plan doesn’t provide coverage, etc.), annuitants 65 or older have a “once-in-a-lifetime” opportunity to change FEHB plans any month of the year. However, most annuitants will choose to save this option for later in life, just in case that have an urgent reason to want to switch plans mid-year. Event Code 2L on the OPM Form 2809 allows for this: https://www.opm.gov/forms/pdf_fill/opm2809.pdf
Question: If I have additional questions later, could I email you or call you?
Answer: Please email fedbenefits@narfe.org.
Question: Could you explain what “Hold Harmless” is and why the premium is different if you are not eligible because you were part of CSRS?
Answer: Please email our advocacy department at advocacy@narfe.org.
Question: Is Medicare Part D ever appropriate with Medicare Parts A & B combined with any FEHB plan (i.e., BC FEP Blue Focus)?
Answer: Prescription drug coverage under FEHB is almost always, if not always, better than Part D.
Question: Is there a decrease in the Federal Health plan when you have Medicare A & B?
Answer: Regardless of whether you sign up for Medicare or not, the premiums for the various FEHB plans in retirement are the same as those for full-time federal employees. The reason why typically requires a conversation to properly understand. Feel free to email us at fedbenefits@narfe.org if you want to have that conversation sometime.
Question: I turned 65 in November. It is my understanding that I have until 2/28/21 to decide on whether I’ll get Medicare Part B. Due to a house sale, my MAGI was very high in 2019 so would prefer not to sign up for Medicare until the last possible moment in 2021 as my monthly Medicare Part B cost would be in the $475/mo category for 2021. Any suggestions?
Answer: Since your IEP (initial enrollment period) overlaps the annual GEP (general enrollment period), I recommend sending us an email with your phone number so we can assist you with specifically timing your Medicare enrollment to minimize your costs while simultaneously assist you with avoiding any possible late enrollment penalty. This is always best suited for a one-on-one conversation and we help NARFE members with this sort of thing every month on a case-by-case basis.
Question: How is the reimbursement from a FEHB program effected? Do you get sent a check yearly or how?
Answer: Some plans will send you a check/direct deposit and some will pay Social Security directly to reduce your cost. Each plan handles this a little differently, each plan will provide instructions for this in the plan brochure, website and when you enroll in the plan itself.
Question: If you enroll in an FEHB Advantage plan and then decide to go back to a FEHB regular plan plus Medicare Parts A & B, is that allowed?
Answer: Sure, you may switch plans during every Open Season or once-in-your-lifetime if you choose to use QLE 2L outside of Open Season on OPM Form 2809 https://www.opm.gov/forms/pdf_fill/opm2809.pdf
Question: How do I contact Tammy to become one of her clients?
Answer: Tammy’s company information is: RetireFederal. You can email info@retirefederal.com.
Question: I will turn 65 six months after retirement. If I change my plan then (instead of waiting for Open Season), will that be a QLE or a “once-in-a-lifetime”?
Answer: That “once-in-a-lifetime” event is listed as a QLE on the OPM Form 2809. Event Code 2L https://www.opm.gov/forms/pdf_fill/opm2809.pdf
Question: I have Self Plus One coverage in a FEHB and FEDVIP plan that require coordination for dental claims. If I chose a new FEHB plan that coordinates with Medicare but doesn’t cover any dental services, does the dentist still need to send claims to the FEHB plan as primary, which would decline payment, and then send the claim to my FEDVIP plan?
Answer: That’s a good question. If your new health insurance does not provide coverage for specific dental or vision benefits, then I would only provide the dentist or the optometrist with my FEHB plan info if they asked for it. I would imagine that if you switch to an FEHB plan that doesn’t provide such coverage, all you would have to do is provide the dentist or optometrist with your FEDVIP plan info. You should double check what I said here by simply calling the toll-free number of the FEDVIP plan you enroll with and speak with one of their customer service reps about this.
Question: If you’re over 65, but within the special enrollment period for recent retirees, is enrolling in Medicare Part B a qualfying event all by itself?
Answer: That’s a good question. The act of enrolling is not the actual qualifying life event (QLE) that allows annuitants to switch FEHB plans outside of an Open Season. The fact that you are eligible for Medicare is what allows you to use that once-in-a-lifetime QLE event code 2L on the OPM Form 2809 to switch plans. Some annuitants save this for later just in case they find themselves wanting to switch from a low option FEHB plan back to a high option FEHB plan in the middle of any given year for any personal reason later in life. For example, I have BCBS Basic which does not provide coverage for out-of-network services. If my doctor tells me I need an expensive out-of-network surgery in the next month or two, Medicare Part B would help with that but if I can’t afford the part of that bill that Medicare doesn’t pay for, that’s an example where I might wish I had saved that “once-in-a-lifetime option” to switch back to BCBS Standard effective the 1st of the next month so I can get that surgery fully covered by both Medicare Part B and BCBS Standard.
Question: Was the Aetna Direct plan you mentioned the consumer driven plan or the high deductable plan or some other plan? I couldn’t find a simple Aetna direct plan in the Checkbook comparison.
Answer: The Aetna Direct plan falls under the CDHP (Consumer-Driven health plan) category. On both the OPM and the Consumers’ Checkbook Guide plan comparison tool websites, the enrollment codes for Aetna Direct are: Self Only (N61), Self Plus One (N63).
Question: I am well past 65, still working and have not yet enrolled in Medicare. Will I be penalized?
Answer: The answer depends on where you have your FEHB coverage. Are you still working as a fed OR are you retired from federal service and working in the private sector? If you are still covered by employment FEHB through your agency as an active federal employee, then you will have an 8-month special enrollment period to sign up for Medicare with no penalty once you retire from federal service. For more details, read the SEP info here: https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods
Question: Can you change from Self Plus One to Self and then back to Self Plus One?
Answer: The answer is yes, but when and how you can do that depends on whether you are an active federal employee or an annuitant. Active employees can refer to the SF2809 form for details on what they can do with their plans and the OPM Form 2809 provides details what an annuitant can do with their plans. Unlike active employees, annuitants can switch from a Family or Self Plus One plan down to a Self Only plan any month of the year whereas employees typically need a qualifying life event (QLE) to do so outside of an Open Season. Both employees and annuitants typically need a QLE to swtich from Self Only back to Self Plus One outside of an Open Season.
SF2809 for employees: https://www.opm.gov/forms/pdf_fill/sf2809.pdf
OPM Form 2809 for annuitants: https://www.opm.gov/forms/pdf_fill/opm2809.pdf
Question: Is it better to suspend FEHB and subscribe to Medicare Parts B & C?
Answer: I would suggest watching Tammy’s webinar from October 2020 to get a sense of your options. If you still have questions, email us at fedbenefits@narfe.org.
Question: How do we know if our current doctors participate in the plans?
Answer: The best advice we can give is to simply call your doctor’s office to ask.
Question: What is the biggest mistake you see federal retirees make with this decision?
Answer: The biggest mistake that I see federal retirees make with this decision is not taking into account what their out-of-pocket expenses might actually look like years down the road when they begin to experience “unhealthy years”. At the age of 65 (or date of retirement from federal service, whichever is later), they need to think like an 85 year old. They should be using the online tools Tammy discussed and they should speak with FEHB plan customer service reps and ask for some examples of out-of-pocket expenses both with and without Medicare Part B to determine whether or not they can afford such expenses and compare that with the cost of paying for the Medicare Part B premiums.
Question: If I turn 65 years old in February 2021, should I sign up for Medicare now or wait until February? If I sign up now for Part B, will I start paying premiums now or when I turn 65 years old in February 2021?
Answer: The earliest you will pay for Medicare Part B and be covered is the month of your birthday (February). You may enroll starting this month, but your coverage won’t take effect until February. If you enroll after your birthday, your coverage (and premiums) will be delayed. Your initial enrollment period lasts for 3 months after your birthday (March, April, May).
Question: Trying to decide which BCBS option coordinates best with Medicare B. The Focus Option wasn’t discussed.
Answer: The Focus option isn’t designed for retirees with Medicare.
Question: What is a formulary?
Answer: The formulary for your health plan provides a list of medications that a team of health care specialists have approved. It is all about prescription drug coverage and what each individual insurance plan will cover and at what copay/coinsurance to the consumer.
Question: Could you please clarify when one spouse is over 70 and one is under 65 and both in good health, how to identify the best plan for the couple?
Answer: There are many plans that have very good benefits for healthy seniors. If you have no chronic health problems, you may choose a lower option plan, but beware of issues that could require immediate care such as a fall, stroke or other sudden need for expensive care. I would recommend a plan with a very good inpatient benefit ($0 out-of-pocket if possible). If you both have Medicare A & B, then perhaps one of the Advantage Plans or plans offering good Medicare incentives might be your best option.
Question: Could you explain what if any Medicare coordination incentives Standard Option BCBS has?
Answer: There is not a Medicare reimbursement with the BCBS Standard Option. However, it does have a Medicare wrap around.
Question: What kind of coverage do FEHB Advantage Plans offer spouses under 65 years of age?
Answer: There is usually a higher deductible for the non-Medicare eligible spouse and be careful of the higher copays and coinsurance. I might recommend a more traditional health plan until the spouse catches up. The Kaiser plans are an exception. I don’t believe they require both spouses to enroll in the Advantage option.
Question: Is there ever a reason to have Medicare Parts A & B, High PPO BC/BS, and Tricare for Life?
Answer: There might be many reasons. One example I hear all the time is this: “I enjoy my TRICARE coverage but my spouse doesn’t enjoy it as much, so my spouse wants me to keep our FEHB coverage unsuspended so she can use that as her secondary to Medicare without ever needing to get involved with TRICARE. But if I end up outliving my spouse, I’m thinking I might suspend FEHB for TRICARE, knowing that I could always use any future Open Season and get back into FEHB later if desired.”
Question: I will sign up for Medicare Part B that will start in July 2021 and switch to a Medicare reimburseable FEHB plan in July 2021. Will I get the full year reimbursement?
Answer: There should be information regarding the pro-ration of the reimbursement in the plan brochure and also on the plan website. Most FEHB plans have a “Medicare” link on their website with extensive information about how that plan coordinates with Medicare.
Question: In the Checkbook Guide to Health Plans, neither Aetna Direct nor Aetna Advantage or United Advantage (Retiree Advantage) is rated for quality. They are “NR”. What have you heard about their quality or rating?
Answer: They often don’t have ratings especially if they are somewhat new and OPM hasn’t had time yet to collect enough data, especially the new Advantage plans. However, we have heard many good things from people using Aetna Direct for years and we heard some good reports earlier this year from the people who tried out the new Advantage plans in 2020.
Question: I don’t want to have to file paperwork for Medicare (Parts A & B) and with FEHB – is there a plan that does that for me?
Answer: This is in the BCBS Plan Brochure, but all providers are required by law to submit your claims to Medicare and Medicare will coordinate with your secondary payer. Claims process when you have the Original Medicare Plan. You will probably not need to file a claim form when you have both our Plan and the Original Medicare Plan.
When we are the primary payor, we process the claim first.
When the Original Medicare Plan is the primary payor, Medicare processes your claim
first. In most cases, your claim will be coordinated automatically and we will then provide
secondary benefits for the covered charges. To find out if you need to do something to file
your claims, call us at the customer service phone number on the back of your Service
Benefit Plan ID card or visit our website at www.fepblue.org.
Question: Why won’t BCBS offer the reimbursement incentives for BCBS Standard, when I want to have the option to go out-of-network?
Answer: To encourage you to enroll in Basic.
Question: Do all Advantage plans include overseas coverage?
Answer: Usually this is covered under the FEHB plan (not the Advantage part of the FEHB plan). Think of it like a plan inside of a plan. The FEHB plan is the outside and the Advantage benefits are inside the FEHB plan. Always check your plan brochure or call the 800 number to ask specific questions.
Question: Besides BlueCross, what plans have Medicare reimbursement?
Answer: Visit the NARFE Open Season page for this info – https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841 the charts are about halfway down the page
Question: Where do I go to access certain FEHB service benefit plan brochures electronically? Also, how do I obtain a copy of 1 or 2 selected FEHB service benefit plan brochures?
Answer: Visit the plan websites.
Question: When we turn 65 in the middle of the year, how does transition to Medicare as primary occur? Is it automatic or do we have to submit paperwork to FEHB?
Answer: When you enroll in Medicare, you don’t need to change health plans right away (but you could if you wish). It is important to call your health plan to let them know that you have enrolled in Medicare Parts A & B so that they will process your claims properly. Also be sure to let your medical providers know once your enrollment is effective as well. Communication is key!!
Question: For drugs, do I need to send claim to Medicare or is BlueCross BlueShield primary for drugs so I don’t have to go thru Medicare?
Answer: When you fill your outpatient prescriptions you will use your FEHB plan. Medicare covers some medications received while receiving inpatient care.
Question: Does Consumer Checkbook discuss Medicare coordination?
Answer: Yes
Question: Does Medicare Part B look each year at tax returns from 2 years prior to come up with each year’s premium?
Answer: Yes
Question: Isn’t turning age 65 and enrolling in Medicare a qualifying life event, allowing you to change your plan choice outside of Open Season?
Answer: Yes
Question: Can I appeal IRMAA once I retire based on income in the year of/year before I sign up for Medicare Part B?
Answer: Yes
Question: Is turning 65 and signing up for Medicare Parts A & B a life event so that I can change FEHB plan in the middle of the season?
Answer: Yes. https://www.opm.gov/healthcare-insurance/life-events/
Question: Is turning 65 a life event so that I can change FEHB plan in the middle of the season?
Answer: Yes, if signing up for Medicare.
Question: Do both BlueCross Standard and Basic option provide the wrap around feature?
Answer: Yes they do, however, BCBS only provides this when using BCBS Preferred Providers. If you go out of this network with BCBS Basic, then Medicare Part B may cover the expense, but you will have a 20% coinsurance.
Question: Did you say that BCBS Basic also has wrap around coverage?
Answer: Yes, BCBS Basic does have wrap around coverage.
Question: Is the drug formulary with the mail service prescription plan for BC Basic the same as Standard mail service drug formulary IF you have Medicare Part A & B?
Answer: Yes, https://www.fepblue.org/pharmacy/prescriptions, however the formulary is different between Standard, Basic and Focus: https://www.fepblue.org/open-season/whats-new-2021
Question: Does Open season occur at same time every year? I am planning to retire at the end of 2021.
Answer: Yes, it’s the second Monday in November through the second Monday in December.
Question: Does the Foreign Service Benefit Plan offer “Wrap-Around” benefits?
Answer: Yes
Question: I plan to enroll in Medicare Part B but don’t plan to enroll in Social Security for another couple of years. Can the Medicare Part B premium be paid out of a Social Security deduction?
Answer: Yes
Question: I am not retired and not age 65 yet, but is it true that I can sign up for a Self Plus Family FEHB even though it is me and my wife (Self Plus One)?
Answer: Yes, and if your plan is cheaper for Self Plus Family, you should.
Question: I am retired. If I did not enroll in a FEDVIP plan before retirement, can I sign up in retirement?
Answer: Yes, FEDVIP does not have the same 5 year requirement as FEHB.
Question: Are there any high deductible plans that work with Medicare Part B?
Answer: Yes. NARFE compiled the following lists to help you make a more informed decision about your FEHB and Medicare coverage including Medicare reimbursements during the 2020 federal benefits Open Season. You can access the charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading. Look for HDHP.
Question: Is Tammy Flanagan available for counseling of retired federal employees concerning Medicare?
Answer: Yes. Please visit her website at retirefederal.com.
Question: Can I go back to original Medicare from Medicare Advantage program both under Kaiser?
Answer: Yes. https://healthplans.kaiserpermanente.org/federal-employees-fehb/medicare/
Question: Does BCBS Basic cover out-of-network providers in an emergency situation or where an in-network specialist doesn’t exist?
Answer: Yes, in some cases. Under the BCBS Basic Option, you must use Preferred providers in order to receive benefits, except under the situations listed below. In addition, they must approve certain types of care in advance.
Please refer to Section 4, Your Costs for Covered Services, for related benefits information.
Exceptions:
1. Medical emergency or accidental injury care in a hospital emergency room and related
ambulance transport as described in Section 5(d), Emergency Services/Accidents;
2. Professional care provided at Preferred facilities by Non-preferred radiologists,
anesthesiologists, certified registered nurse anesthetists (CRNAs), pathologists, emergency
room physicians, and assistant surgeons;
3. Laboratory and pathology services, X-rays, and diagnostic tests billed by Non-preferred
laboratories, radiologists, and outpatient facilities;
4. Services of assistant surgeons;
5. Care received outside the United States, Puerto Rico, and the U.S. Virgin Islands; or
6. Special provider access situations, other than those described above. We encourage you to
contact your Local Plan for more information in these types of situations before you receive
services from a Non-preferred provider.
Question: Does each plan have a way of checking what my current prescriptions would cost under their plan?
Answer: Yes, most FEHB plan websites will have formulary tools or lists of prescription drugs, although some (like BCBS) have excellent tools that let you browse multiple pharmacy locations with exact prices. Other FEHB plans might only list the names of their drugs and you may have to call one of their customer service reps to look up the prices for you.
Question: Can you comment on if prescription costs are usually included in catastophic maximums?
Answer: Yes, since prescription drug copays/coinsurances are not typically waived even though other hospital/doctor service copays/deductibles often are when Medicare Parts A & B are primary to the FEHB plan coverage, the copays/coinsurance out-of-pocket expenses for prescription drugs will typically count toward the in-network (and out-of-network when if applicable) catastrophic limits each year.
Question: If I add Medicare Part B to complement my FEHB plan (Kaiser No. California), will Medicare Part B allow me the option to use a health practitioner outside of Kaiser?
Answer: Yes, that is one of the benefits of combining Medicare with Kaiser in addition to many of the Kaiser plans offer a very generous Medicare reimbursement.
Question: If my income drops due to retirement will the Medicare Part B premium drop automatically due to IRMAA in the next couple of years or when?
Answer: Yes, that is possible as the SSA/Medicare folks automatically communicate with the IRS each year to determine premiums for the upcoming year. If subject to the IRMAA, you might consider taking a look at the SSA-44 form and appeal the IRMAA if possible: https://www.ssa.gov/forms/ssa-44-ext.pdf.
Question: Isn’t there a summary page within each insurance plan brochure? If so, how can I locate that?
Answer: Yes, the summary at the back of each plan brochure can be helpful. There are good summaries available on the plan websites and under the website’s Medicare information links.
Question: Can I go back to Standard Option later if I want to switch to Basic? Currently I have Standard Option and Medicare Part A & B.
Answer: Yes! You can either wait for an Open Season to switch back or you can use event code 2L on the OPM Form 2809 (which is something that you can only do once in your lifetime) and switch back to BCBS Standard or any other FEHB plan that you desire without waiting for the next Open Season.
Question: I already have Medicare Parts A & B. Can I still get an Advantage plan?
Answer: Yes, you must have enrolled in Medicare Parts A & B to be eligible to enroll in a Medicare Advantage Plan (it is a 2-step process with the FEHB Advantage options). The enrollment process is explained on the plan website, plan brochure and to you directly once you enroll in the plan.
Question: Due to current employment, I expect to be impacted by IRMAA for Medicare Part B when I turn 65 next year. Is the premium recalculated annually?
Answer: You can appeal IRMAA if you were working when the Medicare premiums were calculated but now you’ve retired and your income is different. https://www.hhs.gov/about/agencies/omha/the-appeals-process/part-b-premium-appeals/index.html
Question: I am the federal retiree and my husband is on my FEHB but he is now turning 65 in December. I am younger. He wants to use AARP Medicare Advantage Plan. I want to keep him on the my FEHB. How does this work if I want to use a HDHP?
Answer: You can be enrolled in a HDHP, but if your husband has Medicare and is covered under your plan, you won’t be able to contribute to the HSA. Also, some of the HDHP plans don’t provide “wrap around” coverage with Medicare (MHBP HDHP does, however).
Question: Is there a limit to the number of times you can change plans as a retiree?
Answer: You can change during every Open Season if you’d like.
Question: Are there counselors to help you make the choice, like there are for Medicare Advantage programs? I am overwhelmed with the amount of information to synthesize to make a good choice.
Answer: You can check out Tammy’s offerings at retirefederal.com
Question: Can I go back to BCBS Standard option later if I switch to BCBS Basic now? I have Federal BCBS Standard option now.
Answer: You can go back during the next Open Season if it’s not for you.
Question: How does Blue Focus interact with Medicare?
Answer: You can go to the following website and read section 9 of the BCBS Blue Focus plan brochure to address that question, but BCBS didn’t specifically design that plan for annuitants with Medicare as their primary coverage. https://www.fepblue.org/-/media/PDFs/Brochures/FEP-Blue-Focus-brochure-2021.pdf
Question: Can you provide a link or reference to tell me what I should know about formulary prescriptions?
Answer: You can look at the charts that NARFE created for you. All of the plans have a link to the formulary for that plan. You can find the charts here: https://www.narfe.org/communications/index.cfm?fa=viewArticle&ID=4841. Look for the FEHB PLANS WITH MEDICARE REIMBURSEMENT heading.
Question: For drugs, do I need to send claim to Medicare or is BlueCross BlueShield primary for drugs so I don’t have to go through Medicare?
Answer: When you fill your outpatient prescriptions you will use your FEHB plan. Medicare covers some medications received while receiving inpatient care.
Question: I am retired with a disability. Medicare is effective March 1, 2021 for me. The card SS sent me says: HOSPITAL (PART A) and Medical (Part B). What does this mean and where can I research my total premiums?
Answer: You can use the tools on the following website to see your 2021 FEHB premium: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/
Medicare Part A will probably be premium free.
and you can use the following web page to see what your 2021 Medicare Part B premium will be: https://www.medicare.gov/your-medicare-costs/part-b-costs
Question: I’m still confused about Medicare Advantage Plans? Does one suspend Medicare B? How do they compare to choosing Medicare Parts A & B with a “Non-Advantage” FEHB plan?
Answer: You cannot have a Medicare Advantage plan under Medicare Part C without having both Medicare Parts A & B. And it wouldn’t typically make sense to have an Advantage plan under the FEHB program unless you had both Medicare Parts A & B. Although there are exceptions (Tammy mentioned some of those in her webinars), most federal retirees will have Medicare Parts A & B, and will want to compare the regular FEHB plans with the ones that are typically designed with Medicare in mind. For example, if you have always had BCBS Standard before reaching the age of 65, you might want to compare BCBS Standard with BCBS Basic and if you are thinking about switching to BCBS Basic, you would also want to take a closer look at plans such as Aetna Direct or any other FEHB plan with the word “Advantage” in it’s name.
Question: In several retirement seminars I attended, it was stated that even though we’re federal employees, we still need to sign up for a part of Medicare the year you turn 62. What part is that if that is true?
Answer: You can’t sign up for Medicare until you turn 65 and you do not have to sign up until you retire or ever if you don’t want to.
Question: If I have Medicare is there a deductible for BlueCross Blue Sheild?
Answer: Your deductible for BCBS Standard option is waived if Medicare is your primary insurance.
Question: Can one use the Checkbook and OPM comparison tools to compare Aetna Direct and Aetna Medicare Advantage?
Answer: Yes