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Medicare + FEHB Webinar
Medicare + FEHBWebinar
Brian SperlingSenior Account ManagerGEHA
Mickey BasiAccount ManagerGEHA
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Agenda1. FEDVIP in retirement2. FEHB rules about retirement3. Medicare Parts A and B4. Should I enroll in Part B?5. How and when should I enroll in Medicare?6. Medigap or Medicare supplement plans7. Medicare Part C / Medicare Advantage8. Medicare Part D / prescription coverage9. GEHA medical and dental plans
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OPM frequently asked questionsopm.gov/Retirement-services/Retirement-faqs
FEDVIP – Federal Employees Dental and Vision Insurance Plan
No 5 year requirement Enrollment allowed in retirement Immediate annuity required
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FEHB regulations –Knowing the ground rules
Cannot re-enroll if canceled after retirement
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When enrolling in: Medicare Advantage Plan or Tricare
FEHB regulations –Knowing the ground rules
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Re-enrollment is allowed during: Open Season Involuntarily terminated by plan Move out of the plan’s service area
FEHB regulations –Knowing the ground rules
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Post-retirement plan changes
Only a click away: Health care needs change Change in family status
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Post-retirement plan changes
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Post-retirement plan changes
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Post-retirement enrollment changes
Premiums deducted post-tax Can reduce enrollment to Self Plus One or Self Only Can cancel FEHB at any time Know rules to re-enroll, very limited circumstances
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Post-retirement enrollment changes
Changes allowed for life events Retirement is not a life event Family coverage not required at retirement
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Post-retirement enrollment changes
Survivorship benefits Lifetime coverage for survivor annuitants
Survivorship benefits – Lifetime coverage for survivor annuitants
Enrolled in Self Plus One or Family plan upon death
Family member must be entitled to annuity as survivor
Monthly benefit after your death required
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The original Medicare
Part A: premium free Part B: monthly premium
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You should consider delaying enrollment in Part B if you are still actively employed. You will not be penalized for late enrollment.
Medicare Part A – Premium free
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Inpatient hospital
Skilled nursing facility
Home health care
Hospice care
Medicare Part A – Premium free
Deductible $1,364, first 60 days
Daily copay $341/day from 61-90 days $682/day from 91-150 days
Most FEHB plans waive these costs when Medicare is primary
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Covers 80% after 2020 annual deductible
of $185
Part B
Equipmentand supplies
Outpatienttherapies
Ambulance Office visits
Outpatient facilities
Hospitalvisits
Outpatient labsOutpatient radiology
Part B Premiums for 2019
File Individual Tax Return*
File Joint Tax Return*
Part B Premium You Pay
$85,000 or less $170,000 or less $135.50
$85,001–$107,000 $170,001-$214,000 $189.60
$107,001–$133,500 $214,001-$267,000 $270.90
$133,501–$160,000 $267,001-$320,000 $352.20
$160,001-$499,999 $321,000-$749,999 $433.40
$500,000 and above $750,000 and above $460.50
91% of beneficiaries in 2019
*Amount based on modified adjusted gross income as reported on your IRS tax return from 2 years ago.
Part B Premiums
$3
$135.50
$135.50 x 12
1966 2019
Medicare enrollment
Social Security enrolls, sends card CMS administers Medicare
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Medicare enrollment
Automatic enrollment if already receiving benefits
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Medicare enrollment
Automatic enrollment if already receiving benefits
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Medicare card mailed3 months before birthday
Medicare enrollment
Applying for benefits Eligibility window of seven months
Three months before the month you turn 65 Your birthday month Three months after you turn 65
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65th birthday
Applying for benefits General Enrollment Period is from
January 1 - March 31 Coverage would begin on July 1 Penalty may apply
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Medicare enrollment
Medicare enrollment Applying for benefits Still working? Apply for Part A
Premium free You’ve earned it Reduce your out-of-pocket costs
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Medicare enrollment Applying online is easy Visit ssa.gov/Medicare
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Late enrollment penalty
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Can I enroll in Part B later?
Premium x .10 = Permanent Penalty (first year) Premium x .20 = Permanent Penalty (second year) Premium x .30 = Permanent Penalty (third year)
Late enrollment penalty
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Late enrollment exception –for those 65 and older
Covered by FEHB as an active employee
OR
Covered by your spouse’s employer group plan
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Late enrollment exception –for those 65 and older
Most people delay enrollment Health plan is the primary payer Medicare is the secondary payer
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Late enrollment exception –for those 65 and older
Special Enrollment Period Eight month timeframe Begins the month after you retire
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Medicare supplement or Medigap plans
Pays Medicare deductibles & coinsurance Additional monthly premium Does not cover prescription drugs Not needed for federal retirees FEHB & Medicare will coordinate benefits to
provide comprehensive coverage for federal retirees
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Medicare Part C / Medicare Advantage
Must be enrolled in Part A & B Part C substitutes for Part A & B Covers some of Part A & B expenses:
Part A deductible $1,364 Part B coinsurance 20%
Most FEHB plans will not waive their copays and deductibles when an Advantage plan is primary
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Medicare Advantage –Regional HMOs & PPOs
Premiums and costs vary widely Some care may require preauthorization or
referrals to see specialist Limited network possible May only cover emergency care outside your
service area In areas of higher competition, Advantage plans
can be a good value They may include vision, dental or fitness benefits
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Medicare Part D –Prescription drug coverage
Prescription drug coverage Separate monthly premium
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Review your plan options
Review FEHB plans before Medicare becomes primary
Becoming eligible for Medicare is a Qualifying Life Event (QLE) Change allowed to any option or any
available plan Begins the 30th day before becoming eligible
for Medicare Only allowed once
Lower premium plans may be adequate in the early years of retirement
Plan changes allowed every year during Open Season
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Why should I pay Part B premiums?
Doesn’t my FEHB cover the same things?
Most FEHB FFS (Fee For Service)
Pay 100% of most medical expenses Waive deductibles and coinsurance Allow out-of-network, no referrals Waive hospital pre-certification Coverage overseas Some plans offer Part B rebates Lower premium plans may save you as much as
plans offering Plan B rebates
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Most FEHB HMOs
Reduce or waive copays and deductibles Network limitations may still apply Some offer private Medicare Advantage plans
comparable to FEHB HMO plans Some FEHB HMOs offer separate enhanced
benefit plans specific to federal employees
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Electronic filing
FEHB coverage without Part B
Deductibles, copays and coinsurance apply Higher out-of-pocket expenses Consider health status preceding age 65 Compare your plan’s catastrophic limit to
Part B premiums
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Summary of Medicare and plan options
Medicare and plan options Premiums you pay
A + B + FEHB Part B + FEHB
C + FEHB Part B + private insurance + FEHB (FEHB doesn’t waive cost-sharing)
Part C only (Suspend FEHB) Part B + private insurance (premiums & coverages vary widely)
A + FEHB (no Part B) FEHB Only
A + B + Tricare (Military Retirees) Part B OnlyA + B + Medigap/Supplement + Part D (Not for FEDS)
Part B + private insurance + Part D premium
How GEHA works with Medicare A&B
With Medicare A & B, GEHA’s Standard and High Option plans offer:
Up to $600 in reimbursements per calendar year.
Deductibles, copays and coinsurance waived whether your provider is in- or out-of-network.
Covered inpatient and outpatient hospital services, surgeries and office visits, at no cost to you.
Coverage when you’re out of the country, where Medicare does not cover you
This amount may be used on Medicare Part B premium payments for High Option plan members enrolled in Medicare Parts A & B.
geha.com/medicare
GEHA dental plans
Question & Answer
Brian SperlingSenior Account ManagerGEHA
Thank you!
