Federal Employees Health Benefits (FEHB) Program. Webcast: December 16, By: Kate Schilling, BSSA

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1 Federal Employees Health Benefits (FEHB) Program Webcast: December 16, 2011 By: Kate Schilling, BSSA

2 Table of Contents FEHB Intro and program features Who is eligible for FEHB plans? What are the types of FEHB plans? FEHB and Medicare Coordination of Benefits

3 FEHB Introduction Administered by the Office of Personnel Management (OPM) In plans (206 choices) Benefits cover more than 8 million people (including retirees, spouses, families) Program Features No. No limitations. 3

4 Eligibility Employees Most are eligible to enroll Retirees Can continue FEHB coverage into retirement if they meet and. If retirees drop their coverage while they are retired,. NOTE: Retirees can their coverage if: Enrolled in MA plan TRICARE, CHAMPVA Medicaid Use Peace Corps health insurance coverage 4

5 FEHB Premiums Premiums vary by plan and option Generally, enrollees pay about % and their agency or retirement system pays about %. Employees and retirees pay the same amount. More info on premiums available at: 5

6 Plan changes can be made: During Annual Open Season (Monday of 2 nd full workweek in through the Monday after the 2 nd full work week in.) o Call o Send a letter to: FEHB Open Season Processing Center, P.O. Box 5000, Lawrence, KS Qualifying Life Event Becoming eligible for Marriage, divorce, death, birth, move, etc. Annuitants can cancel FEHB enrollment or change to self-only coverage at any time. To make changes outside of Open Season, call Retirement Info Center at or retire@opm.gov. 6

7 Types of Health Plans Fee-for-Service (FFS) with Preferred Provider Organization (PPO) HMO Consumer Driven Health Plan High Deductible Health Plan Fee-for-Service plans Nationwide o Some open to all employees & retirees o Some open only to specific groups Fewer costs incurred if PPO provider is used Paperwork/requirements if PPO provider not used. HMO plans Must or in service area to enroll Plans operate in a specific service area only Must use and get from PCP 7

8 Out of pocket costs are generally just Little paperwork, managed care concept Consumer Driven Health Plans (CDHP) Combines traditional health plan with separate medical and dental funds Annual medical and dental funds used first for covered expenses When medical fund is, a deductible must be met before traditional health insurance coverage becomes effective Remaining medical fund dollars may be, helping to reduce out of pocket expenses. High Deductible Health Plans Provides coverage for high-cost medical events and a tax-advantaged way to build for future medical expenses. o Annual and. 8

9 Premium contribution to Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA). withdrawals from accumulated funds to pay for qualified out of pocket expenses including annual deductible. Health Savings Account vs Health Reimbursement Arrangement HSA Enrollee make deposits HRA Enrollee make deposits earn interest earn interest Portable Not portable 9

10 FEHB and Medicare Parts A & B FEHB fills many of the gaps in Medicare for services covered by FEHB plans. FEHB coverage is similar to an policy with excellent drug benefits. o FEHB may pay for some services Medicare doesn t, unlike supplement. Some FEHB plans some of their cost sharing for enrollees with Medicare (when Medicare is primary payer). They do not, however, generally waive cost sharing for prescription drugs. o FEHB may have Rx coverage than Part D. 10

11 Age 65 Still Working and Have FEHB Part A: OPM advises employees who can get Part A for free to take it. Employees should let their FEHB health plan know that they enrolled into Part A. Part B: Part B usually not necessary while still working remains primary payer Apply for Part B upon retirement (8 month SEP) 11

12 Age 65 and Retired Part A: Annuitants who can get Part A for free are advised to take it. Let FEHB health plan know. Part B: Depends on and. Retired and have a Fee-For-Service Plan Medicare Part B and FEHB may combine to provide for all medical expenses. FEHB FFS plans continue to pay for all benefits like. 12

13 Retired and Have an HMO plan FEHB HMO enrollees may not need Part B. FEHB HMO s provide most medical services for. FEHB HMO enrollees may not receive added value by enrolling in Part B. NOTE: If the FEHB HMO enrollee, or wants to see providers outside the HMO network, Part B is recommended. What if clients have TRICARE? If retired from military, you must enroll in Part A and B to keep TRICARE. If active-duty member, you don t need to have Part B to keep TRICARE. Coordination of Benefits with TRICARE: pays first is the second payer is the third payer 13

14 FEHB and Medicare Advantage Plans Retirees can enroll in any Medicare Advantage plan they are eligible for. Must be enrolled in Medicare A & B. Some FEHB plans offer MA plans. Can suspend FEHB if enrolled in MA plan. FEHB Suspension If Member loses coverage under Advantage plan Member disenrolls from Advantage plan Then Immediate reenrollment in FEHB is Re-enrollment cannot take place until next 14

15 FEHB and Part D Plan comparison tool on FEHB website. No formularies online. Use plan brochure, or contact retirement office of employer. All FEHB plans have prescription drug coverage that is to Medicare Part D. Who should consider enrolling in Part D? Federal retirees will benefit from enrolling in Part D and paying extra for prescription drug benefits. However, retirees with limited resources may want to enroll if they qualify for. 15

16 Coordination of Benefits Member or spouse has Medicare and FEHB, and member... has FEHB as an active employee or spouse... has FEHB as a retired annuitant or spouse The primary payer is: Re-employed Annuitants Re-employed Annuitant Employed in a position that conveys FEHB eligibility Employed in a position that does NOT convey FEHB eligibility Primary 16

17 What if I am enrolling in Medicare and my spouse is younger than 65? Retirees must maintain coverage for self and family if want coverage for spouse No enrollment just for spouse unless spouse is eligible for FEHB in her own right 17

18 Key Issues to Remember Medicare not required if enrolled in FEHB; People should contact their health plan when they turn 65 (for coordination of benefit purposes); Can defer Medicare (with no penalty) if still employed; Can submit documentation to SSA for exclusion to means testing; Medigap policy generally not needed with FEHB; Medicare Part D not needed in most cases; Retirees can suspend FEHB as long as enrolled in an Advantage plan (& not pay FEHB premiums, no limit in time). 18

19 Resources OPM s Federal Benefits Website: FEHB Plan Brochures (by state and plan) OPM s FEHB Website FEHB and Medicare Booklet /75-12-FINAL.pdf **Portions of this training material were taken from the National Medicare Training Program webcast on FEHB and Medicare 19