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FEHBP and Medicare Coordinating Coverage

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

  2. 1960 FEHBP • Public Law 86-382 • Largest group insurance in world • Covers 8 million enrollees • 200+ choices • Open Seasons • OPM Oversight www.narfeny.org

  3. 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

  4. 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?

  5. 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 (TTY1-800-325-0778) 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.

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 Other Significant Dates • 1988 • Medicare Catastrophic Coverage Act • 1989 • Medicare Catastrophic Coverage Act Repealed • 1997 • Balanced Budget Act of 1997 • Medicare + Choice (Medicare Part C or Medicare Advantage) • 2003 • Medicare Prescription Drug, Improvement and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

  7. 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

  8. Medicare Part A- Hospital Insurance You pay (or FEHBP or Tricare For Life) (2012): • 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 and FEHBP

  9. 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 30th 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

  10. What about HMO’s? • Kaiser • 100 days in Kaiser facility with some co-pays • Aetna • 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 • CareFirst BlueChoice • No dollar or day limit if Plan doctor determines necessary Kaiser Permanente Federal Employees aetna Federal Employees

  11. 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

  12. Cost Depends $99.90 (2012) • More expensive if AGI income greater than $85,000 or $170,000 for joint filers) • Per person • 2013 increase cannot exceed COLA (1.7%) Medicare Website Monthly Premium Could be higher!

  13. 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

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

  15. Compare Benefits Medicare FEHBP (Kaiser)

  16. Compare Benefits Medicare FEHBP – BC/BS

  17. First Click:“Health”Then, Click:PlanInformation Compare FEHBP Plans 2013

  18. Check Section 9 of FEHBP Brochure

  19. Check Section 9 of FEHBP Brochure

  20. Choose a less expensive FEHB Plan

  21. Choose a less expensive FEHB Plan

  22. Choose a less expensive FEHB Plan

  23. When to Enroll? Medicare Enrollment Period Publication

  24. Initial Enrollment Period

  25. Special Enrollment Period

  26. General Enrollment Period

  27. 3 Medicare and You 2013 Publication