Optimizing FEHB Health Insurance and Medicare for...

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Optimizing FEHB Health Insurance and Medicare for Federal Employees 2015

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OPTIMIZING FEHB HEALTH INSURANCE AND MEDICARE FOR FEDERAL EMPLOYEES BY EDWARD A. ZURNDORFER

ABOUT THE AUTHOREdward A. Zurndorfer is a retiree of the federal government and is currently the owner of EZ Accounting and Financial Services, an accounting and financial service firm in Silver Spring, MD. He is a Certified Financial Planner (CFP), a Chartered Life Underwriter (CLU), Chartered Financial Consultant (ChFC), Registered Health Underwriter (RHU) and Registered Employee Benefits Consultant (REBC). He is also an IRS Enrolled Agent, licensed to represent taxpayers before the IRS. His firm specializes in the areas of individual taxes, tax preparation and consulting, employee benefits consulting in the areas of health and life insurance and retirement planning.

Mr. Zurndorfer writes for Federal Employees News Digest (FEND). He is the author of numerous other 1105 Media Inc. publications. He has written numerous articles in national and local financial journals, including the National Public Accountant, the Maryland Society of Accountants Journal, and the National Society of Enrolled Agents Journal.

He is also the moderator of 1105’s popular FederalSoup.com question-and-answer forum. He conducts retirement and benefits seminars throughout the country for federal employees, as well as seminars on the Thrift Savings Plan, long-term care insurance, and the government’s new flexible spending accounts program.

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TABLE OF CONTENTS1. Introduction

2. Types of Programs Offered by Medicare

3. Federal Employees, Medicare Eligibility and Enrollment Rules

4. Why Federal Employees Enrolled in a FEHB Plan Should Enroll in Medicare Parts A and B When First Eligible

5. Coverage and Costs Associated with Medicare Parts A and B

6. Consequences of Not Enrolling in Medicare When First Eligible

7. When an FEHB Plan is Primary/Secondary; and When Medicare is Primary/Secondary

8. Effect on FEHB Premiums When an Employee/Annuitant Enrolls in Medicare

9. What an Employee/Annuitant Should Do With FEHB Once Enrolled in Medicare

10. What Happens if an Employee/Annuitant Wants to Enroll in a Medicare Advantage Plan or a Tricare Health Insurance Plan

11. How the Affordable Care Act Affects the FEHB Program and Medicare

12. Future Changes Coming to Medicare and What Employees and Annuitants Need to Know

Appendix: FEHB and Medicare Terminology and Links to Websites for Additional Information

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OPTIMIZING FEHB HEALTH INSURANCE AND MEDICARE FOR FEDERAL EMPLOYEES 2015

CHAPTER 1: INTRODUCTION

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1. IntroductionOne of the most often asked questions made by active or retired federal employees is: “What is the coordination between the Federal Employees Health Benefits (FEHB) program and Medicare? In particular, how do the two programs work together?” In addition, many employees and retirees have questions as to how their FEHB program premiums are affected once they enroll in Medicare.

Enrolling in Medicare for the first time is a relatively easy task for most individuals age 65. In fact, for those individuals receiving Social Security retirement checks before their 65th birthday the Social Security Administration (SSA) will automatically enroll those individuals in Medicare Part A and Part B. There are, however, a growing number of individuals who find enrolling in Medicare is a bureaucratic nightmare, particularly those individuals who are not receiving Social Security retirement checks at age 65. The enrollment rules can also be particularly perplexing for federal employees who retire after age 65 with their FEHB health insurance. It is also easy to inadvertently miss a Medicare enrollment deadline. The possible consequences of late Medicare enrollment are months without Medicare coverage and a lifetime of penalties.

This publication hopefully will answer all employees’ and retirees’ questions regarding the coordination between FEHB insurance and Medicare, including when to enroll in Medicare and which Medicare program is most appropriate and applicable for


CHAPTER 2: TYPES OF PROGRAMS OFFERED BY MEDICARE

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a federal employee or retiree. It also explores the relationship between other insurance programs and Medicare. For example, this publication also discusses the relationship between Medicare and a spouse’s health insurance, and between Medicare and the Tricare program’s group health insurance coverage for current and retired members of the uniformed services.

2. Types of Programs Offered by MedicareIndividuals who are eligible for Medicare benefits may enroll in original Medicare (Parts A and B) or choose to get their benefits from several Medicare Advantage Plans (Plan C) options. Depending on where a federal annuitant lives, Part C options may include Medicare Advantage Plans that are approved by Medicare but run by private insurance companies. Medicare Advantage plans offer Medicare Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private fee-for-service plans (PFFS), Medicare Special Needs Plans and Medicare Savings Account (MSA) plans.

The Medicare Prescription Drug Improvement and Modernization Act established a voluntary outpatient prescription drug benefit program. Medicare enrollees are able to receive prescription drug coverage by enrolling in a Medicare Part D plan. Medicare Advantage Plans (Medicare Part C) may also offer



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prescription drug coverage that follows the same rules as Medicare Part D coverage.

Types of Expenses Covered By Medicare Part AMedicare Part A (hospital insurance) helps pay for: (1) inpatient hospital care; (2) critical access hospitals; (3) skilled nursing facility care; (4) some home health care; (5) hospice care and (6) prescriptions dispensed in a hospital. Additional information about Medicare A benefits during 2016 is presented in Table 1. Note that Medicare Part A does not include catastrophic coverage (major medical) or custodial (long-term) care.



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Table 1. Medicare Part A (Hospital Insurance) Covered Services Per Benefit Period During 2016

Services You PayBlood In most cases, the hospital gets blood from a blood

bank at no charge, and you won’t have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated.

Home Health Care

You pay:• $0 for home health care services• 20% of the Medicare-approved amount for durable medical equipment

Hospice Care You pay:• $0 for hospice care • A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management • 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest)• Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

Hospital Inpatient Stay

You pay:• $1,288 deductible per benefit period • $0 for the first 60 days of each benefit period • $322 per day for days 61-90 of each benefit period • $644 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stay

You pay:• $0 for the first 20 days each benefit period • $161per day for days 21-100 each benefit period • All costs for each day after day 100 in a benefit



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Types of Expenses Covered by Medicare Part BMedicare Part B (medical insurance) helps pay for: (1) doctor’s expenses; (2) ambulance services; (3) outpatient hospital care; (4) X-rays and laboratory costs; (5) durable medical equipment and supplies; (6) some home health care (if one does not have Medicare Part A); (7) certain preventive care; (8) other outpatient services; and (9) some other medical services Medicare Part A does not cover such as physical and occupational therapy.

Medicare Part B does not pay for most routine dental care, eyeglasses, hearing aids, most immunizations or most prescription drugs. Beginning in January 2011, Part B covers an annual wellness visit in which plan enrollees are provided a personalized prevention plan, including a health risk assessment.

Additional information about Medicare B benefits during 2016 is presented in Table 2, on the following page.



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Table 2. Medicare Part B (Medical) Insurance-Covered Services Per Benefit Period During 2015

Services You PayPart B Deductible You pay $166 per year.

Blood In most cases, the provider gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it. However, you will pay a copayment for the blood processing and handling services for every unit of blood you get, and the Part B deductible applies. If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else. You pay a copayment for additional units of blood you get as an outpatient (after the first 3), and the Part B deductible applies.

Clinical Laboratory Services

You pay: $0 for Medicare-approved services.

Home Health Services You pay: $0 for Medicare-approved services. You pay 20% of the Medicare-approved amount for durable medical equipment.

Medical and Other Services

You pay: 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy*, and durable medical equipment.

Mental Health Services You pay: 40% of the Medicare-approved amount for most outpatient mental health care.

Other Covered Services You pay: copayment or coinsurance amounts.

Outpatient Hospital Services

You pay: a coinsurance (for doctor services) or a copayment amount for most outpatient hospital services. The copayment for a single service can’t be more than the amount of the inpatient hospital deductible.

*There may be limits on physical therapy, occupational therapy and speech language pathology services.

Note: If the period of hospitalization covers two calendar years, no new deductible is required for the new year. These figures are for 2016 and are subject to change each year.



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Additional Information on Medicare Part CThe original Medicare program created in 1965 consists of Part A and Part B and operates as a “fee-for-service” system. Under this program, a Medicare beneficiary can go to any physician or health care supplier nationwide that accepts Medicare payments.

In 1997, the federal government created as Medicare Part C, the Medicare + Choice program. This new program was designed to give Medicare beneficiaries access to a wide array of more cost-effective, private health plan choices as an alternative to the traditional Parts A and B. In 2003, Medicare + Choice was renamed “Medicare Advantage” as part of the Medicare Prescription Drug Improvement and Modernization Act.

In general, each Medicare beneficiary is entitled to choose to receive benefits either through original Medicare Parts A and B or through a Medicare Advantage plan. The Medicare Advantage plan options include: (1) health maintenance organizations (HMOs); (2) point-of-service plans; (3) preferred provider organizations (PPOs); (4) provider-sponsored organizations (PSOs); and (5) private fee-for-service plans (PFFs).

An annual enrollment period takes place each November. Elections made during this annual enrollment period take effect Jan. 1 of the following year.

Federal retirees who are covered by a Federal Employees Health Benefits (FEHB) plan or military retirees covered by Tricare for Life usually do not need Medicare Part C.



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Federal retirees may suspend their FEHB coverage during the FEHB open season held in November through early December and enroll in a Medicare Advantage Plan to eliminate the FEHB monthly premium. Federal retirees may re-enroll in an FEHB plan during a subsequent FEHB open season, assuming they had previously suspended their FEHB coverage.

Additional Information about Medicare Part D - Prescription Drug CoverageMedicare Part D provides insurance coverage for prescription medications. Under this program, insurance companies and other private firms contract with Medicare (Medicare pays most of the premiums) to provide prescription drug benefits to Medicare beneficiaries.

Each eligible Medicare beneficiary must select a drug plan and pay a monthly premium to receive the drug coverage. All drug plans (the choice varies by state) must provide coverage at least as good as the standard coverage specified by Medicare. Some plans may offer extra benefits such as no deductible or higher coverage limits, or cover additional drugs in exchange for a higher monthly premium. Individuals with limited income and resources may qualify for help in paying for drug coverage.

Federal retirees who are covered by an FEHB plan or military retirees covered by Tricare for Life do not need Medicare Part D. FEHB plans in general have prescription drug coverage that is, on average, expected to pay out as much as the standard Medicare prescription drug coverage.


CHAPTER 3: FEDERAL EMPLOYEES, MEDICARE ELIGIBILITY AND ENROLLMENT RULES

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It is important to note that FEHB program prescription drug coverage is an integral part of an employee’s or a retiree’s total health benefits package. An employee or a retiree cannot suspend or cancel FEHB program prescription drug coverage without losing FEHB plan coverage in its entirety. This includes coverage for hospital and doctor services, laboratory tests and medical equipment.

3. Federal Employees, Medicare Eligibility and Enrollment Rules In general, an individual is eligible for Medicare if the individual or the individual’s spouse worked for at least 10 years in Medicare-covered employment, is age 65 or older and is a citizen or permanent resident of the United States. If the individual is not yet age 65, then the individual may also qualify for coverage if he or she has a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant).

Since all federal employees have paid the Medicare Part A payroll tax (hospital insurance) since 1983, all current and future federal employees are eligible to enroll in Medicare. Employees or annuitants who have reached age 65 are eligible to enroll in Medicare. Those annuitants who retired under a disability retirement before 65 and who have received Social Security disability benefits for 24 months are also eligible to enroll in Medicare.



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Those employees or annuitants who are already receiving Social Security retirement benefits are automatically enrolled in Medicare Parts A and B in the month they become age 65. Those employees who are close to age 65 and not receiving Social Security benefits must apply for Medicare by contacting the Social Security Administration. But as will be discussed, those employees who continue to work for the federal government and who are enrolled in an FEHB insurance plan should enroll only in Medicare Part A and not Medicare Part B.

Initial Enrollment PeriodAn individual who already receives Social Security benefits will not need to do anything when he or she becomes age 65. He or she will be automatically enrolled in Medicare Part A and Part B effective the month the individual is 65. For example, if an individual’s birthday is Oct. 17, 2014, that individual’s Medicare effective date would be Oct. 1, 2014. The Medicare card will be mailed to the individual approximately three months before his or her 65th birthday. If the individual does not want Medicare Part B, then the individual should follow the instructions on the card.

If an individual is not receiving Social Security benefits or Medicare, then the individual should apply for Medicare Part A and Part B by contacting the Social Security Administration by going online at www. socialsecurity.gov, by calling at 1-800-772-1231, or visiting a local Social Security office.

The following is a list of enrollment periods for Medicare Part A and Part B for federal employees: (1) three months



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before the month of, or three months after the employee’s 65th birthday; (2) between Jan. 1 and March 31 of each period during a general enrollment period; and (3) within eight months of retiring from federal service during a special enrollment period. These three enrollment periods are presented in the following charts.

General Enrollment PeriodThe general enrollment period is every Jan. 1 through March 31, with Medicare coverage taking effect the following July. A higher premium for Part B may have to be paid for late enrollment.

Initial Enrollment Period3 months before the month one turns age 65

2 months before the month one turns age 65

1 month before the month one turns age 65

The month one turns age 65

1 month after the month one turns age 65

2 months after the month one turns age 65

3 months after the month one turns age 65

Sign up early to avoid a delay in coverage. In order to get Part A and Part B the month one becomes age 65, sign up during the 3 months before turning 65.

If one waits until the last 4 months of the initial enrollment period to sign up for Part A and/or Part B, the coverage will be delayed up to 3 months after enrollment.

Special Enrollment PeriodCoverage will take effect the first day of the month following enrollment anytime a federal employee or the employee’s spouse is working and the employee is covered by:

(1) the FEHB; or

(2) a spouse’s health plan through an employer or union based on that work.

Or Coverage will take effect the first day of the month following enrollment during the 8-month period that begins the month a federal employee who is enrolled in FEHB retires or the spouse’s group health plan coverage ends, whichever comes first.


CHAPTER 4: WHY FEDERAL EMPLOYEES ENROLLED IN A FEHB PLAN SHOULD ENROLL IN MEDICARE PARTS A AND B WHEN FIRST ELIGIBLE

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4. Why Federal Employees Enrolled in an FEHB Plan Should Enroll in Medicare Parts A and B When First EligibleAs discussed in Chapter 3, most federal employees become eligible for Medicare when they become age 65. Employees are encouraged to enroll in Medicare Part A when they first become eligible. With respect to Part B, an employee who is either enrolled in an FEHB plan or covered through a spouse’s group health plan from a private employer will sign up according to when the employee retires from federal service—before or after 65— or when the spouse under whose group health insurance the employee is covered by at the time of reaching age 65 retires from the company or government sponsoring the group health insurance plan. The following three examples will help illustrate:

Example 1. Jim, age 62, retires from federal service on June 30, 2015. Jim carries his FEHB coverage into retirement. Within two to three months of Jim’s 65th birthday in 2018, Jim will enroll in Medicare Parts A and B.

Example 2. Carol, age 64, is working from the federal government and is enrolled in an FEHB health insurance plan and intends to retire from federal service when she is age 66. Within a few months of her 65th birthday, Carol will enroll in Medicare Part A. When



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she retires from federal service, Carol will enroll in Medicare Part B within eight months following her retirement date from federal service.

Example 3. Frances, age 65, retired from federal service in 2013 and has health insurance through her husband who is a state employee. Her husband continues to work for the state. Frances has enrolled in Medicare Part A but will delay enrolling in Medicare Part B until her husband retires from the state.

Before discussing why it is important for employees to enroll in Medicare Part A and Part B when first eligible, it is important to discuss premium costs associated with Medicare Part A and Part B.

Medicare PremiumsPart A: Employees do not have to pay a premium (nor do their spouses) because they have paid the 1.45 percent payroll tax for at least 10 years.

Part B: Part B recipients pay a monthly premium. The following chart displays the monthly premium costs for Medicare B recipients during 2016.

2016 Medicare Part B PremiumsIf Your Yearly Adjusted Gross Income is....

Then....

Single Married Couple You Each Pay

Change from 2015

$85,000 or below $170,000 or below $121.80 +$16.90

$85,001 - $107,000 $170,001 - $214,000 $170.50 +$23.60

$107,001 - $160,000 $214,001 - $320,000 $243.60 +$33.80

$160,001 - $213,000 $320,001 - $426,000 $316.70 +$44.00

Above $213,000 Above $426,000 $389.80 +$54.10



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Note that the monthly premiums that one pays are based on a Part B recipient’s adjusted gross income (AGI). For 2014, the Social Security Administration determined the monthly Part B premium based on the recipient’s 2012 AGI, which they obtain from the IRS (the individual’s 2012 federal income tax return).

If an individual’s income has decreased from its 2012 AGI level due to any of the situations listed below, and the change will make a difference in the individual’s income level on the above chart, the individual should contact the Social Security Administration to explain that the individual has no information and may need a new decision about the individual’s income-related monthly adjustment amounts. The following situations could have an effect on one’s AGI: (1) the individual marries, divorces or becomes widowed; (2) the individual or the individual’s spouse stopped working or reduced working hours; (3) the individual or the spouse lost income -producing property due to a disaster or other event beyond one’s control; (4) the individual or spouse experienced a termination or reorganization of an employee’s pension plan; or (5) the individual or spouse received a settlement from an employer or former employer because of the employer’s closure, bankruptcy or reorganization.

If any of the five reasons applies, then the Social Security Administration will need to see documentation verifying the event and how the event reduced one’s income. The documentation provided should be related to the event and may include a death certificate, a letter from one’s employer about one’s retirement or



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something similar. A copy of the federal income tax return filed for the year in question should also be filed with the Social Security Administration. Affected individuals should see Form SSA-44, which can be downloaded from www. socialsecurity.gov.

If an individual does not sign up for Part B when first eligible, the individual may have to pay a penalty to get it later. For each 12-month period an individual delays enrollment in Part B, the individual will have to pay an extra 10 percent of the premium. For federal annuitants, that means they must enroll in Part B during the initial enrollment period (see Chapter 3). For those federal employees who retire after age 65, that means a retired employee must enroll within the eight months following their retirement date. The following examples illustrate:

Example 4. Joseph retires from federal service at age 57. Eight years later, near Joseph’s 65th birthday, Joseph needs to enroll in Medicare Part A and Part B to avoid penalty.

Example 5. Jean’s initial enrollment period ended Sept. 30, 2011. She waited to sign up for Part B until the General Enrollment Period in March 2014. Her Part B premium penalty is 20 percent. This is because Jean waited a total of 30 months to sign up, which included only two full 12-month periods (2012 and 2013).


CHAPTER 5: COVERAGE AND COSTS ASSOCIATED WITH MEDICARE PARTS A AND B

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5. Coverage and Costs Associated With Medicare Parts A and BMedicare Part A helps cover the following: (1) inpatient care in hospitals, including critical access, hospitals and inpatient rehabilitation facilities; (2) inpatient stays in a skilled nursing facility, but not custodial or long-term care; (3) hospice care services; (4) home health care services; and (5) inpatient care in a facility that provides nonmedical, non-religious health care items and services to individuals who need hospital or skilled nursing facility care, but for whom that care would not be in agreement with their religious beliefs (a religious nonmedical health care institution).

An individual usually does not pay a monthly premium for Part A coverage if that individual or spouse has at least 40 quarters of Medicare-covered employment. Since all federal employees have paid the Medicare Part A payroll tax (hospital insurance) since 1983, all federal employees are eligible for Medicare Part A.

If an individual is not eligible for premium-free Part A, the individual may be able to buy Part A if the individual meets the citizenship or residency requirement and is age 65 or older, or if the individual meets the citizenship or residency requirements, is under age 65, disabled and the individual’s premium-free Part A coverage ended because the individual returned to work.

Note that the 2015 premium amount for individuals who



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buy Part A is $407 per month or $224 per month for individuals with 30 to 39 quarters of coverage.

Since almost all federal annuitants or employees are entitled to Part A without paying the premiums, they should take Part A. By doing this an employee or annuitant’s hospital (inpatient) costs will be paid, most probably in full, for costs that an FEHB plan may not cover. This includes deductibles, coinsurance and charges that exceed the FEHB plan’s allowable charges that the FEHB plan may not cover. There are other advantages to Part A, such as being eligible to enroll in a Medicare Advantage Plan. This is true only if one is also enrolled in Medicare Part B.

Table 1 in Chapter 2 summarizes what Part A pays during 2015. For federal annuitants 65 and older, Medicare is generally the primary payer and FEHB is the secondary payer. This is true unless the annuitant is covered by health insurance through a spouse’s current employment. This means that Medicare will be billed for payment of medical services first, and FEHBP will be billed for the remainder after Medicare pays. In many cases, an annuitant’s deductible and copayments will be waived under the annuitant’s FEHB plan and the annuitant’s out-of-pocket expenses will be reduced to zero.

Part B helps cover medically necessary services such as doctor services, ambulance services, outpatient and hospital care, X-rays and laboratory tests, durable medical equipment and supplies, some preventive care, other outpatient services and other medical services that Part A does not cover, such as physical and occupational therapy.



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Unlike Part A, which is free for most federal employees and annuitants, an individual pays a monthly premium for Part B. As explained in Chapter 4, most individuals will pay a standard premium amount of $104.90 during 2015. The monthly premium, however, will be higher for certain higher-income individuals.

Federal annuitants do not have to take Part B coverage if they do not want it, and the annuitant’s FEHB cannot require the annuitant to enroll in it. There are advantages to enrolling in Part B, including: (1) an individual must be enrolled in Parts A and B to join a Medicare Advantage Plan; (2) the annuitant has the advantage of coordination of benefits (described in Chapter 7) between Medicare and the annuitant’s FEHB plan, reducing out-of-pocket costs; (3) the annuitant’s FEHB plan may waive its copayments, coinsurance and deductibles for services covered by Part B; (4) some services covered by Part B might not be covered or are only partially by the annuitant’s plan. These include orthopedic and prosthetic devices, durable medical equipment, home health care and medical supplies; and (5) if the annuitant is enrolled in a FEHB HMO, the annuitant may go outside the HMO network for Part B services and receive reimbursement by Medicare, when Medicare is the primary payer.

There are services not covered by Medicare Parts A and B including, but not limited to: (1) acupuncture; (2) chiropractic services; (3) cosmetic surgery; (4) custodial care, except when an individual also receives skilled nursing care in a skilled nursing facility, at home or as part of hospice are; (5) dental care and dentures; (6) eye


CHAPTER 6: CONSEQUENCES OF NOT ENROLLING IN MEDICARE WHEN FIRST ELIGIBLE

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exams (routine); eye refractions; (7) foot care (routine); (8) hearing aids and exams for the purpose of fitting a hearing aid; (9) hearing tests that have not been ordered by an individual’s doctor; (10) long-term care; (11) orthopedic shoes; (12) prescription drugs; (13) syringes or insulin; and (14) travel health care while an individual is travelling outside of the United States.

6. Consequences of Not Enrolling in Medicare When First EligibleBecause all federal employees have paid the Medicare tax during their careers, there is no premium when enrolled in Part A. There is no consequences or penalty for late enrollment if an employee does not enroll in Part A when first eligible—normally around his or her 65th birthday.

When individuals enroll in Part A, they are automatically enrolled in Part B. They should look at the Part B effective date on the front of their Medicare card. If they do not want to keep Part B, they must notify Medicare before that date.

Employees or annuitants do not have to enroll in Part B if they do not want it, and an employee’s or annuitant’s FEHB plan cannot require the employee or annuitant to enroll in it. But there are some advantages in enrolling in Part B, including:

• An individual must be enrolled in Parts A and B to join a Medicare Advantage Plan;


CHAPTER 6: CONSEQUENCES OF NOT ENROLLING IN MEDICARE WHEN FIRST ELIGIBLE

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• Military retirees who are federal employees or annuitants are also eligible for Tricare health insurance coverage (Tricare for Life) once they turn 65. There is no premium cost for Tricare for Life if the individual is also enrolled in Medicare Parts A and B.

• An individual has the advantage of coordination of benefits, described in Chapter 7, between Medicare and the individual’s FEHB plan, reducing or possibly eliminating out-of-pocket costs such as copayments and deductibles.

• The individual’s FEHB plan may waive its co-payments, coinsurance and deductibles for Part B service.

• Some services covered under Part B may not be covered or only partially covered by the individual’s FEHB plan, such as orthopedic and prosthetic devices, durable medical equipment, and home health care and medical supplies.

• An individual enrolled in an HMO may go outside the plan’s network and receive reimbursement by Medicare only if Medicare is the primary payer.

If an individual does not enroll in Part B during the individual’s initial enrollment period (see Chapter 4), the individual must wait for the general enrollment period, Jan. 1 through March 31, and Part B coverage will begin the following July 1 of that year. If the individual waits one year or more after first becoming eligible for Part B but did not sign up, then the Part B monthly premium will increase 10 percent for each 12 months that the individual could have had Part B coverage but did not


CHAPTER 7: WHEN AN FEHB PLAN IS PRIMARY/SECONDARY; AND WHEN MEDICARE IS PRIMARY/SECONDARY

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enroll in it. The extra 10 percent penalty is permanent for as long as the individual has Part B.

The only exception to the extra 10 percent penalty is for those individuals who are active federal employees covered under an FEHB plan or if the individual is covered under a spouse’s group health insurance plan and the spouse is an active employee. In that case, the individual may sign up for Part B, generally without an increased premium, within eight months from the time the individual or spouse is no longer covered by the group plan as an active employee.

7. When an FEHB Plan is Primary/Secondary Payer; and When Medicare is Primary/Secondary PayerMedicare law and regulations determine whether Medicare or FEHB is the primary payer—that is, which pays first. Medicare automatically transfers claim information to a federal employee’s or annuitant’s FEHB plan once the individual’s claim is processed. That means the individual need not file a claim with both payers. The individual will receive an Explanation of Benefits (EOB) from the FEHB plan and an EOB or Medicare Summary Notice (MSN) from Medicare. If the individual has to file with the secondary payer, then the individual should send along the EOB or MSN obtained from the primary payer.



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When is FEHB Plan the Primary Payer?An individual’s FEHB plan must pay benefits first when the individual is an active federal employee or reemployed annuitant, and either the individual or the individual’s covered spouse has Medicare. There is an exception if the individual’s re-employment position is excluded from FEHB coverage or if the individual is enrolled in Medicare Part B only.

An individual’s FEHB plan must also pay benefits first for the individual or the individual’s covered family member during the first 30 months of eligibility or entitlement to Part A benefits because of End Stage Renal Disease (ESRD) regardless of the individual’s employment status. This is, unless Medicare, based on age or disability, was the individual’s primary payer on the day before the individual became eligible for Medicare Part A, due to ESRD.

An individual’s FEHB plan must also pay benefits first when an individual is under age 65, entitled to Medicare on the basis of disability and covered under FEHB based on the individual’s or spouse’s employment status.

When is Medicare the Primary Payer?Medicare must pay benefits first when an individual is a federal annuitant, unless the individual is a re-employed annuitant, and either the individual or the individual’s covered spouse has Medicare. Medicare must pay benefits first when an individual is a former federal employee receiving worker’s compensation and the Office of Worker’s Compensation has determined that the individual is unable to return to duty, except for claims



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related to the worker’s compensation-covered injury or illness.

If Medicare was the primary payer prior to the onset of ESRD, then Medicare will continue to be primary payer during the first 30 months of eligibility to receive Part A benefits solely because of ESRD.

The following table summarizes when Medicare or FEHB is the primary payer.

Medicare and FEHB Primary Payer ChartWhen an individual or the individual’s covered spouse is 65 or older and has Medicare and the individual is...

Primary Payer

Secondary Payer

an active federal employee or has a spouse who is an active federal employee

FEHB Medicare

covered as an annuitant or through a spouse who is an annuitant

Medicare FEHB

a re-employed annuitant with the federal government and position is not excluded from FEHB coverage

FEHB Medicare

a re-employed annuitant with the federal government and position is excluded from FEHB coverage

Medicare FEHB

a federal judge who retired under Title 28, U.S.C., or a Tax Court judge who retired under Section 744 of Title 26, U.S.C.

Medicare FEHB

enrolled in Part B only, regardless of one’s employment status

Medicare FEHB

a former federal employee receiving worker’s compensation and the Office of Worker’s Compensation has determined that the individual is unable to return to duty

Medicare FEHB



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The following example illustrates:

Example 6. Paul, age 68, is a federal annuitant. Paul is enrolled in Medicare Parts A and B and is also enrolled in an FEHB fee-for-service health insurance plan. Paul needs to visit a health care specialist for a medical issue he has. The doctor charges $1,500 for the initial consultation and subsequent medical treatment. Payment by Medicare B is “primary” and Paul’s FEHB plan is “secondary.”

The following summarizes:

1. The doctor bills Medicare for services: $1,500

2. Medicare determines the approved amount: $1,125 (75 percent)

3. Medicare pays the doctor 80 percent of the approved amount: $900

Medicare and FEHB Primary Payer Chart (Cont’d)

When an individual or the individual’s covered family member has Medicare based on End Stage Renal Disease (ESRD) and FEHB and is...

Primary Payer

Secondary Payer

within the first 30 months of eligibility to receive Part A benefits solely because of ESRD

FEHB Medicare

beyond the 30-month ESRD coordination period and is still eligible for Medicare due to ESRD

Medicare FEHB

When an individual or the individual’s covered family member has FEHB and...

Primary Payer

Secondary Payer

is eligible for Medicare based on disability Medicare if an annuitant; FEHB if an active employee

The other payer - FEHB or Medicare



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Note that an annual Medicare Part B deductible of $147 (2015) must be met before Medicare pays. In this example, the deductible has been met. If it has not been met, $147 of the $900 would be applied toward the deductible.

4. Paul’s FEHB plan pays the uncovered out-of-pocket expenses ($225) up to the Medicare-approved amount.

5. Paul’s doctor accepts this assignment* as payment in full since he or she accepts Medicare assignment.

6. Paul is responsible for this amount: $0

*A health care provider who accepts Medicare assignment will accept the Medicare-approved amount as payment in full. Annuitants age 65 and older who do not have Medicare Part B must be treated the same as those who do have Part B for benefit payment purposes. That means the amount doctors and other health-care providers may charge a federal annuitant age 65 and older is limited to 15 percent more than the Medicare-approved fee. Even with the Medicare-approved fee, an annuitant who has chosen not to enroll in Part B will most likely have a deductible and a copayment to pay because the FEHB plan will not pay the amount charged by the doctor.

Note in the previous example that if Paul were not enrolled in Medicare Part B, then he may be responsible for paying the annual FEHB plan deductible and the $375 copayment up to the full cost of the service if it is not covered by the FEHB plan.


CHAPTER 8: EFFECT ON FEHB PREMIUMS WHEN AN EMPLOYEE/ANNUITANT ENROLLS IN MEDICARE

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8. Effect on FEHB Premiums When an Employee/Annuitant Enrolls in MedicareAt the time a federal employee or annuitant enrolls in Medicare Part A and Part B, and Medicare becomes the primary payer of their medical expenses, his or her FEHB premiums will not be reduced. This is true even though Medicare is paying for most of the employee/annuitant’s medical expenses. As will be explained in the Chapter 9, the employee/annuitant could switch to a less expensive FEHB plan or pursue other options.

The fact that FEHB plan premiums are not reduced when Medicare is the primary payer of an employee’s/ annuitant’s medical expenses is unfortunate, especially since the employee/annuitant is paying a premium for the FEHB plan, as well as a monthly premium for Medicare Part B.

Many federal annuitants feel that since their FEHB premiums are not decreased when they enroll in Medicare Parts A and B, they do not enroll in Medicare Part B. While their rationalization is logical, not enrolling in Part B is not going to result in much savings, especially if they are enrolled in a fee-for-service plan.

An FEHB fee-for-service plan will not necessarily cover all of an annuitant’s out-of-pocket expenses. A fee-for-service plan’s payment is typically based on allowable charges, not billed charges. In some cases, Medicare’s


CHAPTER 8: EFFECT ON FEHB PREMIUMS WHEN AN EMPLOYEE/ANNUITANT ENROLLS IN MEDICARE

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payment and the FEHB plan’s payment combined will not cover the full cost. An employee or annuitant’s out-of-pocket costs for Part B services will depend on whether the employee/annuitant’s doctor accepts Medicare assignment. When a doctor accepts assignment, the employee/annuitant can be billed only for the difference between the Medicare-approved amount and the combined payments made by Medicare and the FEHB plan.

When a doctor does not accept assignment from Medicare, the employee/annuitant can be billed up to the difference between 115 percent of the Medicare-approved amount (limiting charge) and the combined payments made by Medicare and the employee/annuitant’s plan.

Medicare will pay its share of the bill and the employee/annuitant’s FEHB plan will pay its share. Some services, such as medical supplies and some durable medical equipment, do not have limiting charges.

One reason that employees age 65 and older can delay their initial enrollment in Part B (and not be penalized) is that as long as they are active employees, they can enroll and participate in a health care flexible spending account (HCFSA). An HCFSA is perhaps the most practical, tax-efficient and least costly method to pay out-of-pocket medical expenses. These expenses include copayments, deductibles and expenses not covered by an FEHB plan. Annuitants, however, cannot participate in an HCFSA, and therefore are encouraged to enroll in Part B in order to minimize, if not eliminate, their out-of-pocket medical expenses.


CHAPTER 9: WHAT AN EMPLOYEE/ANNUITANT SHOULD DO WITH FEHB ONCE ENROLLED IN MEDICARE

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9. What an Employee/Annuitant Should Do With FEHB Once Enrolled in MedicareAnnuitants should note the following facts concerning the coordination of their FEHB plans with Medicare: (1) many of the FEHB fee-for-service plans will waive their deductibles, coinsurance and copayments when Medicare is the primary payer for an annuitant’s medical services and supplies; and (2) some of the HMO plans will provide enhanced benefits when an annuitant is enrolled in Medicare Parts A and B, and the HMO is the primary payer.

If an annuitant is enjoying good health and is not filling many prescriptions every month, the annuitant might consider changing to a lower-cost FEHB plan that provides waivers of the deductibles, copayments and coinsurance when Medicare is the primary payer.

If an annuitant is very healthy with limited drug expenses, the annuitant’s least expensive option may be to suspend FEHB and go with a Medicare Advantage Plan. Under federal law, annuitants can suspend FEHB, enroll in a Medicare Advantage Plan and return to an FEHB plan without penalty if the annuitant needs additional coverage.


CHAPTER 10: WHAT HAPPENS IF AN EMPLOYEE/ANNUITANT WANTS TO ENROLL IN A MEDICARE ADVANTAGE PLAN OR A TRICARE HEALTH INSURANCE PLAN

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10. What Happens If an Employee/Annuitant Wants to Enroll in a Medicare Advantage Plan or a Tricare Health Insurance Plan?When an employee or annuitant enrolls in a Medicare Advantage plan, the employee or annuitant may not need FEHB coverage because the Medicare Advantage plan will provide the employee or annuitant with many of the same benefits. The employee or annuitant should review the Medicare Advantage Plan benefits carefully before making a decision to suspend or cancel FEHB coverage.

Note that there is an important difference between canceling one’s FEHB coverage and suspending one’s FEHB coverage. If an employee or annuitant cancels FEHB coverage, then the employee or annuitant may not reenroll in the FEHB program. But suspending one’s FEHB coverage is different. Any individual who suspends FEHB coverage is eligible to re-enroll in the FEHB program.

An annuitant, survivor annuitant, or former spouse covered under the Spouse Equity provision of FEHB law may suspend their FEHB enrollment in order to enroll in a Medicare Advantage plan (Medicare Part C), Tricare, CHAMPVA, Medicaid or a similar state-sponsored program of medical assistance for the needy; or use Peace


CHAPTER 11: HOW THE AFFORDABLE CARE ACT AFFECTS THE FEHB PROGRAM AND MEDICARE

35 2015

Corps health insurance coverage, but still retain the right to re-enroll in FEHB.

Employees and annuitants should contact their retirement system before making any changes to their coverage, especially if they are considering suspending their FEHB coverage to enroll in a Medicare Advantage Plan. CSRS or FERS annuitants may call OPM’s Retirement Information Office at 1-88USOPMRET (1-888-767-6738) or 202-606-0500 from the metropolitan Washington area, or write to:

Office of Personnel Management Retirement Operations Center P.O. Box 45 Boyers, PA 16017-0045

11. How the Affordable Care Act (ACA) Affects the FEHB Program and MedicareOn March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA) also known as health care reform. Federal employees and annuitants may have questions regarding how health care reform affects their FEHB enrollment and Medicare participation.

Under the PPACA, all individuals are required to maintain minimum essential coverage (MEC), or qualify for an exemption, or make payment when filing


CHAPTER 12: FUTURE CHANGES COMING TO MEDICARE AND WHAT EMPLOYEES AND ANNUITANTS NEED TO KNOW

36 2015

their federal income tax return. All FEHB plans are eligible-sponsored plans and provide MEC. As such, all employees and annuitants need not take any action regarding their FEHB enrollment. Executive branch employees and annuitants need not enroll nor are they required to enroll on any of the state-run health care exchanges.

Related to the passage of the PPACA is that beginning in plan year 2011, FEHB plans have been required to fully cover – with no cost-sharing (deductibles, co-insurance) from enrollees – a number of preventive health services, including childhood immunizations, screenings from cancer, diabetes and high blood pressure.

Annuitants who are enrolled in both FEHB and Medicare also maintain MEC and need not take any action with respect to the PPACA.

12. Future Changes Coming to Medicare and What Employees and Annuitants Need to KnowAs a result of recently passed legislation that sailed through Congress with bipartisan support and that was signed into law by President Obama in April 2015, costs for upper-income Medicare beneficiaries will increase in the near future.



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The legislation that will increase Part B premiums for upper income beneficiaries starting in 2018 is officially called the “Medicare Access and CHIP Reauthorization Act of 2015,” also known as the “Doc Fix” law. The major focus of the Doc Fix legislation is to permanently repair the Medicare method of paying doctors under Medicare, secure permanent funding for low-income Medicare recipients, and ensure that children will be able to get access to health care insurance coverage.

A portion of the Doc Fix legislation includes provisions to change the brackets for setting Medicare Part B Income Related Medicare Adjustment Amounts starting in 2018. Before discussing the change in these brackets, it is important to note that a Part B recipient’s modified adjusted gross income (MAGI)—as obtained by the Social Security Administration (SSA) in any particular year—is determined from the recipient’s federal income tax return two years prior. For example, what Medicare Part B recipients are paying in monthly premiums during 2015 was determined from their 2013 MAGI. This means that while the Doc Fix legislation new MAGI brackets go into effect in 2018, the individual’s 2016 federal income tax return will be used to determine their MAGI and subsequently their 2018 IRMAA Part B monthly premiums.

In particular, starting in 2018 there will be significant changes in the top three MAGI “tiers” or brackets starting in 2018. The current structure sets the upper limit of tier 3 as $160,000 for single/head of household tax filers and $320,000 for married filing jointly tax filers. Effective Jan. 1, 2018, $160,000 and $320,000 will be



38 2015

the beginning of the top income tier or bracket. This means that starting in 2018 more Part B beneficiaries will be paying more in Part B premiums. All of the current (2015) and future (starting in 2018) tiers or brackets, together with current Part B monthly premiums, are shown and summarized below in the table at the bottom of the page.

What this means is that using 2016 Part B monthly premium costs, starting in 2018 a single person with MAGI over $160,000 will pay $389.80 monthly or $4,677.60 per year in Part B premiums (an increase of $146.20 monthly or $1,754.40 annually paid in 2016) while a married couple in which both spouses are over 65 and with MAGI exceeding $320,000 will pay a total of $779.60 monthly or $9,355.20 annually in Part B premiums (an increase of $292.40 monthly or $3,508.80 annually paid in 2016).

There is good news, however, for federal employees and annuitants facing potentially higher Part B premiums.

MAGI Tier IRS Filing Single/Head of Household/IRS Married Filing Jointly HouseholdIRS Filing Single/Head of Household IRS Filing Married Filing Jointly

MAGI Tier

2016 Tax Year & 2017 Tax Year

> 2017 Tax Year 2016 Tax Year & 2017 Tax Year

>2017 Tax Year 2016 Part B Monthly Premium

1 < $85,000 < $85,000 < $170,000 < $170,000 $121.80

2 ≥ $85,001 to < $107,000 ≥ $85,001 to < $107,000 < $170,001 to < $214,000 < $170,001 to < $214,000 $170.50

3 ≤ $107,001 to < $160,000 ≤ $107,001 to < $133,500 ≤ $214,001 to < $320,000 ≤ $214,001 to < $267,000 $243.60

4 ≤ $160,001 to < $213,000 ≤ $133,501 to < $160,000 ≤ $320,001 to < $426,000 ≤ $267,001 to < $320,000 $316.70

5 > $213,000 > $160,000 > $426,000 > $320,000 $389.80



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Starting in 2016 they can employ some financial planning strategies to hopefully blunt the effect of the new MAGI brackets, keeping them in a lower MAGI tier or bracket, thereby resulting in their paying lower Part B premiums. With 2016 (in which year the MAGI will be used to determine 2018 Medicare Part B premiums) approaching, it is important that affected employees and annuitants make these planning strategies an immediate priority.

The key financial planning strategy to minimize or to lower MAGI is to evaluate income sources to identify those sources that will not flow through a federal income tax return as part of one’s adjusted gross income (AGI). Also, it is important to avoid investing in financial assets generating tax-exempt income such as municipal bonds (tax-free interest) or mutual funds generating tax-exempt dividends and capital gains, all of which are included in one’s MAGI. For example, qualified distributions from a Roth IRA, the Roth TSP, or a health savings account are three examples of income that is not included in one’s AGI and flow outside of the MAGI.

Other sources of income that are not included in MAGI are borrowing from the cash value of a permanent life insurance policy or from the equity in one’s house via a home equity loan.

Affected employees and annuitants are strongly encouraged to consult with a knowledgeable and experienced financial professional who can advise in developing an appropriate strategy to minimize one’s future MAGI.



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It is important to emphasize that the increased costs for Part B monthly premiums will not take effect until 2018, based on an individual’s 2016 MAGI. This means that affected employees and annuitants should take action during the remainder of 2015 to lower their MAGI for 2016 and beyond. For example, converting traditional IRAs to Roth IRAs, or for federal annuitants, making their one-time traditional TSP transfer to a Roth IRA and paying the tax due in 2015, will result in none of this otherwise taxable income showing up as MAGI in 2016 and beyond.

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Appendix1. Terms used in this booklet2. Important FEHB forms3. Important Websites

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Terms Used in This BookletAssignment: An arrangement in which a doctor or health care supplier agrees to accept the Medicare approved amount (see definition) as full payment for services and supplies covered under Part B. When your doctor accepts assignment, you can be billed only for the difference between the Medicare-approved amount and the combined payments made by Medicare and any secondary payer.

Coinsurance: The amount that you pay (after you pay any plan deductibles) for each medical service you get, such as a doctor visit. Coinsurance is a percentage of the cost of the service; a copayment is usually a fixed dollar amount you pay for a service.

Coordination of Benefits: When you have more than one type of insurance which covers the same health care expenses, one insurer pays its benefits in full as the primary payer and the other(s) pays a reduced benefit as a secondary or tertiary payer. When the primary payer doesn’t cover a particular service but the secondary payer does, the secondary payer will pay up to its benefit limit as if it were the primary payer.

Copayment: The amount that you pay for each medical service you get, like a doctor visit. A copayment (or copay) is usually a

43 2015

fixed dollar amount you pay for a service; coinsurance is a percentage of the cost of the service.

Deductible: The amount you must pay for health care before your health plan begins to pay. There is a deductible for each benefit period—usually a year. There may be separate deductibles for different types of services. Deductibles can change every year.

Disenroll: Leaving or ending your health care coverage with a health plan.

Durable Medical Equipment (DME): Medical equipment ordered by a doctor for use in the home. DME must be reusable. DME includes walkers, wheelchairs and hospital beds.

Enroll: You enroll when you first sign up to join a health plan.

Health Maintenance Organization (HMO): A type of health benefits plan that provides care through a network of doctors and hospitals in a particular geographic or service area. HMOs coordinate the health care services you receive. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where you work. Some FEHB HMOs have agreements with providers in other service areas for non-emergency care if you travel or are away for home for lengthy periods.

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Home Health Care: Home health care includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speech-language therapy, and medical social services. These services must be ordered by a physician and are provided by a variety of skilled health care professionals at home. Important: Medicare does not cover long-term care, so this home health care coverage is limited.

Hospice Care: A program for caring for the terminally ill that emphasizes palliative and supportive services, such as home care and pain control, rather than curative care of the terminal illness. These services include nursing care, medical social services, physician services, and short-term inpatient care for pain control and acute and chronic symptom management.

Inpatient Care: All types of health services that require an overnight hospital stay.

Medicare: The federal health insurance program for people 65 years of age or older, certain younger people with disabilities and people with End-Stage Renal Disease (those with permanent kidney failure who need dialysis or a transplant, sometimes called ESRD).

Medicare Advantage Plan: A Medicare program offered by a private company that contracts with Medicare to provide you with all of your Part A and Part B benefits. The Medicare Advantage Plan is called Part C. Medicare Advantage Plans

45 2015

include HMOs, PPOs, Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and are not paid for under the Original Medicare plan. Some Medicare Advantage Plans offer prescription drug coverage and may charge a monthly premium and require copayments.

Medicare-Approved Amount: The amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare. It includes what Medicare pays and any deductible, coinsurance or copayment that you pay. It is usually less than the actual charge.

Medigap: A supplemental private insurance policy that you can buy for extra benefits either not covered or not fully covered by Medicare. There are 12 standard Medigap plans in most states, ranging from a basic benefits package to ones that cover expenses such as the Part A deductible, Part B deductible, prescription drugs, and/ or the skilled nursing coinsurance.

Original Medicare: The traditional fee-for-service arrangement that covers Part A and Part B services. Medicare pays its share of the Medicare-approved amount and you pay your share (deductibles and coinsurance).

Out-of-Pocket Costs: Health care costs that you must pay because they are not covered by insurance, such as deductibles, coinsurance, copayments and non-covered expenses.

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Outpatient Care: Health services that do not require an overnight hospital stay.

Preferred Provider Organization (PPO): A fee-for-service option under Medicare Advantage Plans where you pay less if you use providers who have agreements with the plan. You may use providers outside of the PPO network but the services may cost you more.

Premium: The amount you pay monthly or biweekly for insurance.

Preventive Care: Care to keep you healthy or to prevent illness, such as routine checkups and flu shots, and some tests like colorectal cancer screening and mammograms.

Primary Payer: When coordinating benefits, the health plan that pays benefits first for a claim for medical care.

Private Fee-for-Service Plan: A traditional type of insurance you can choose under Medicare Advantage plans that lets you use any doctor or hospital, but you usually must pay a deductible and coinsurance or copayment. The insurance plan, rather than the Medicare program, decides how much it will pay the provider and how much you will pay for the services you receive. You may pay more or less for Medicare covered benefits but you may get extra benefits not found in Original Medicare.

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Referral: Your primary care doctor’s written approval for you to see a certain specialist or to receive certain services. Most FEHB HMOs and some Medicare health plans may require referrals. Important: If you see a different doctor from the one on the referral, or if you see a doctor without a referral and the service isn’t for an emergency or urgently needed care, you may have to pay the entire bill.

Secondary Payer: When coordinating benefits, the health plan that pays benefits after the primary payer has paid its full benefits. When an FEHB fee-for-service plan is the secondary payer, it will pay the lesser of a) its benefits in full or b) an amount that when added to the benefits payable by the primary payer, equals 100 percent of covered charges.

Service Area: The geographic area where a health plan accepts members. For plans that provide coverage only when you use their doctors and hospitals, it is also the area where services are administered.

Skilled Nursing Facility: A facility that specializes in skilled nursing care performed by or under the supervision of licensed nurses, skilled rehabilitation services, and other related care, and which meets Medicare’s special qualifying criteria. Does not include institutions that primarily care for and treat mental diseases. Important: Medicare does not cover long-term care, so this skilled nursing facility coverage is limited.

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Suspension of FEHB Enrollment: When you notify your retirement system that you are suspending your FEHB coverage to enroll in a Medicare Advantage plan, you retain the right to re-enroll in FEHB if your enrollment in the Medicare Advantage plan ends. Otherwise, if you cancel your FEHB coverage as an annuitant, you will probably never be eligible to re-enroll.

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Some Important FEHB and Medicare Forms1. SF 2809* Employee Health Benefits Registration Form (May be used to enroll or re-enroll in the FEHB program, change one’s enrollment in the FEHB program, or suspend one’s enrollment in the FEHB program.)

2. SF 2810* Notice of Change in Health Benefits Enrollment

3. SSA-44** (Used to appeal to the Social Security Administration the amount of one’s monthly Medicare Part B premium based on adjusted gross income.)

*May be downloaded from http://www.opm.gov/forms **May be downloaded from http://www.socialsecurity.gov

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Important FEHB, Medicare and Tricare Websites1. Important information about the Federal Employees Health Benefits Program http://www.opm.gov/insure/health/index.asp

2. Important information about Medicare http://www.medicare.gov

3. Information about Tricare http://www.military.com and www.militaryauthority.com/tricare/

4. Information about enrolling for Medicare online http://www.socialsecurity.gov/online/

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