tammy flanagan senior benefits director national institute of transition planning, inc
TRANSCRIPT
Tammy FlanaganSenior 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
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
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?
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.
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1989 ◦ Medicare Catastrophic Coverage Act Repealed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
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
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
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
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
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
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
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
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
FEHBP (Kaiser)Medicare
FEHBP – BC/BSMedicare
2013
Compare FEHBP Plans
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
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
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
Medicare Enrollment Period Publication
Medicare and You 2013 Publication
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