FEHBP and Medicare Coordinating Coverage

Tammy FlanaganSenior Benefits Director

National Institute of Transition Planning, Inc.

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

www.narfeny.org

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

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?

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.

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1989 ◦ Medicare Catastrophic Coverage Act Repealed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

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

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

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

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

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

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

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

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

FEHBP (Kaiser)Medicare

FEHBP – BC/BSMedicare

2013

Compare FEHBP Plans

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

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

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

Medicare Enrollment Period Publication

Medicare and You 2013 Publication

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