FEHBP and Medicare Coordinating Coverage
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Transcript of FEHBP and Medicare Coordinating Coverage
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Tammy FlanaganSenior Benefits Director
National Institute of Transition Planning, Inc.
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FEHBP◦Public Law 86-382◦Largest group insurance in world◦Covers 8 million enrollees◦200+ choices◦Open Seasons◦OPM Oversight
www.narfeny.org
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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
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Medicare for Federal employees
P.L. 97-248◦ Tax Equity and Fiscal Responsibility Act of
1982 January 1, 1983
Who would Who would benefit frombenefit from
this change?this change?
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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.
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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1989 ◦ Medicare Catastrophic Coverage Act Repealed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
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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
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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
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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% coverageDays 21 – 100: covered all but $144.50 / dayAfter 100 days: no coverage
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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
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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
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Monthly Premium Could be higher!
$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
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Advantages Disadvantages
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
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Advantages Disadvantages
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
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FEHBP (Kaiser)Medicare
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FEHBP – BC/BSMedicare
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2013
Compare FEHBP Plans
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Plan Self Family
APWU High Option $132.72 $300.10
BC and BS Service Benefit Plan – Standard Option
$186.14 $433.63
BC and BS Service Benefit Plan – Basic Option
$127.99 $299.70
GEHA Benefit Plan – High Option $197.51 $468.86
GEHA Benefit Plan – Standard Option $97.36 $221.41
MHBP – Standard Option – Medicare Pilot Program
$209.32 $504.59
MHBP – Value Plan $93.40 $222.69
NALC $160.66 $326.04
SAMBA – High Option $248.19 $637.52
SAMBA – Standard Option $131.71 $300.81
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Plan Self Family
Virginia Aetna Open Access – Basic (HMO)
$133.79 $304.25
Virginia Aetna Open Access – High (HMO)
$436.06 $982.17
Virginia Aetna HealthFund – Value $124.38 $282.43
Virginia Kaiser Foundation Health Plan Mid-Atlantic States – High (HMO)
$152.81 $381.76
Virginia Kaiser Foundation Health Plan Mid-Atlantic States – Standard – (HMO)
$94.45 $217.24
Virginia CareFirst Blue Choice - High (HMO)
$156.08 $360.62
Virginia CareFirst Blue Choice – Standard (HMO)
$135.27 $304.32
Virginia M.D. IPA (HMO) $166.96 $417.79
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Plan Self Family
APWU CDHP $94.58 $212.77
GEHA HDHP $104.96 $239.74
MHBP – HDHP $134.40 $304.55
Virginia Aetna Health Fund – HDHP $103.76 $227.22
Virginia Aetna HealthFund – CDHP $158.71 $378.69
Virginia CareFirst Blue Choice – HDHP $127.44 $284.25
Compass Rose Health Plan (Restricted Plan)
$154.57 $385.19
Foreign Service Benefit Plan (Restricted Plan)
$124.11 $305.79
Rural Carrier Benefit Plan (Restricted Plan)
$189.73 $311.37
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Medicare Enrollment Period Publication
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Medicare and You 2013 Publication
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