270 likes | 395 Vues
FEHBP and Medicare Coordinating Coverage. Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc. 1960. FEHBP Public Law 86-382 Largest group insurance in world Covers 8 million enrollees 200+ choices Open Seasons OPM Oversight. 1965. Medicare
E N D
FEHBP and MedicareCoordinating Coverage Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc.
1960 FEHBP • Public Law 86-382 • Largest group insurance in world • Covers 8 million enrollees • 200+ choices • Open Seasons • OPM Oversight www.narfeny.org
1965 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
1983 Medicare for Federal employees • P.L. 97-248 • Tax Equity and Fiscal Responsibility Act of 1982 • January 1, 1983 Who would benefit from this change?
Section 9 of FEHBP Plan Brochures 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.
Other Significant Dates • 1988 • Medicare Catastrophic Coverage Act • 1989 • Medicare Catastrophic Coverage Act Repealed • 1997 • Balanced Budget Act of 1997 • Medicare + Choice (Medicare Part C or Medicare Advantage) • 2003 • Medicare Prescription Drug, Improvement and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
Medicare Part A – Hospital Insurance 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
Medicare Part A- Hospital Insurance 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
Medicare Part A – Hospital Insurance 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% coverage Days 21 – 100: covered all but $144.50 / day After 100 days: no coverage
What about HMO’s? • 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
Medicare Part B – Doctors / Outpatient • 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
Cost Depends $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 Monthly Premium Could be higher!
Medicare Part B with BC/BS Style FEHBP Plan – (FFS/PPO) • 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
Medicare Part B with HMO • 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 Advantages Disadvantages
Compare Benefits Medicare FEHBP (Kaiser)
Compare Benefits Medicare FEHBP – BC/BS
First Click:“Health”Then, Click:PlanInformation Compare FEHBP Plans 2013
When to Enroll? Medicare Enrollment Period Publication
3 Medicare and You 2013 Publication