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Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc.

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Page 1: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

Tammy FlanaganSenior Benefits Director

National Institute of Transition Planning, Inc.

Page 2: Tammy Flanagan Senior 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

Page 3: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 4: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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?

Page 5: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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.

Page 6: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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1989 ◦ Medicare Catastrophic Coverage Act Repealed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

Page 7: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 8: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 9: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 10: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 11: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 12: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 13: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 14: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 15: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

FEHBP (Kaiser)Medicare

Page 16: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

FEHBP – BC/BSMedicare

Page 17: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

2013

Compare FEHBP Plans

Page 18: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc
Page 19: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc
Page 20: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 21: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 22: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

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

Page 23: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

Medicare Enrollment Period Publication

Page 24: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc
Page 25: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc
Page 26: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc
Page 27: Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc

Medicare and You 2013 Publication

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