By Reg Jones
Q. I am in CSRS. I want to retire Jan. 11, 2014, as I will be on a mission trip out of the country from Christmas until Jan. 9, 2014, and I would like to get paid for my unused annual leave for 2012. I understand that I will not receive a retirement check for that month since it is past the third day of the month. I have had Federal Employees Health Benefits coverage since Jan. 12, 2009. Does that qualify as five years of health coverage? What will happen to my health coverage for the rest of January as I won’t receive a check for that month?
Q. I’ve been retired from for a year and soon will be 65. I have to keep medical for my wife, so if I keep a family plan under Federal Employees Health Benefits, do I need to pay for Medicare Part B? If not, can I apply for it in the future without a penalty after my wife turns 65?
Q. My disabled adult child is covered under my Federal Employees Health Benefits. How can I ensure that she will remain covered by FEHB after I pass on?
Q. I am a retiree from Tinker Air Force Base, Okla., with health insurance. Turning 65. What happens about Medicare, and which insurance is primary? Does the health insurance turn to a supplement policy? Do you need Medicare A & B? I have only signed up for Medicare A.
Q. 1. I left the Fed in November 2011 with 22 years of creditable service (military time buyback included) and, as I am under my MRA of 56, would not be eligible for my retirement benefits without penalty until age 62, correct? 2. Can I work part time (consultant) on an agency’s payroll without affecting my current status, or would that part time add to my benefit? 3. Also, if I came back to the Fed and did three more years of full-time work before age 62, would that reinstate my health benefits?
Q. I am retired CSRS. I’m marrying a woman who has a minor child. Can I have the child on my Federal Employees Health Benefits and/or as a survivor under any circumstance short of outright adoption?
The Affordable Care Act — Obamacare — is already affecting the Federal Employees Health Benefits Program. In this column, I’ll fill you in on some of the new requirements imposed on FEHBP.
Implemented in 2011 is the requirement that allows children up to age 26, regardless of their marital status, to remain on or be added to the self-and-family option of a parent’s plan. The child does not have to reside with that parent, be financially dependent on the parent, or be a student. Coverage doesn’t extend to a child’s spouse or children.
With one exception, when coverage ends under a parent’s plan, the child may continue that coverage on a self-only enrollment for up to 18 months under the Temporary Continuation of Coverage provision of the law. If the child does that, he or she must pay the entire premium, plus 2 percent to cover administrative costs. The exception: An unmarried child who was disabled before age 26 can continue to be covered under the parent’s self-and-family plan.
The law now requires plans to offer certain preventive care and screening. FEHBP plans have long covered many of these. And since 2011, the Office of Personnel Management has required that plans waive cost-sharing when its enrollees use in-network providers for this care.
The law also now requires plans to provide applicants and enrollees with a summary of benefits and coverage, plus a glossary of terms. The purpose is to give consumers straightforward information about their benefits. While the OPM had already gone a long way toward making it possible for federal employees and retirees to understand what their benefits are and to compare plans, the stricter requirements were imposed on FEHBP plans this year.
Historically, FEHBP plans haven’t imposed lifetime dollar limits on any health condition or kind of service. Beginning in 2013, the law requires this of all plans.
This year, OPM requires FEHBP plans to comply with the requirement that enrollees be allowed to participate in clinical trials. This opens up an area of medical care and scientific investigation where coverage by FEHBP plans had been sparse.
The law that established FEHBP more than 50 years ago prohibited plans from excluding coverage of pre-existing conditions on any enrollee, regardless of age. Beginning in 2014, the Affordable Care Act will bar such exclusions under all plans for any enrollee under age 19.
Since 2011, large group plans, including those in FEHBP, have been required to provide rebates if the ratio of the amount of revenue expended on clinical claims and health quality costs is less than 85 percent, after adjustment for taxes and regulatory fees. Any rebates will be deposited in the FEHBP program’s reserve and used to reduce the cost of that plan’s premiums the following year.
If you are enrolled in a flexible spending account (FSA) or health savings account (HSA), you may have already felt the effects of the Affordable Care Act’s restrictions. Since 2011, the law hasn’t allowed over-the-counter medicines to be covered unless they are prescribed by a physician. The only exception to that rule is insulin. However, other eligible items that aren’t medicine or drugs, such as bandages, won’t require a prescription.
FSAs and HSAs may be used to pay for the qualified expenses of any children who are under 26 and covered by your self-and-family plan, regardless of their financial dependence on you. But beginning this year, the law lowered the maximum annual contributions you can make to these accounts from $5,000 to $2,500. From now on, the contributions threshold will be indexed to inflation.
Q. I was on Blue Cross/Blue Shield for 15 years through my husband’s employment with a city, but the city contracted with Coventry Health Care instead, about one year and two months ago. I have also been with Tricare (formerly CHAMPUS) through my husband’s retirement from the Navy in 1993. We are divorcing after 37 years of marriage, and I would like to switch to BC/BS in FEHB through my federal employment. If I retire before I have vested five years in BC/BS, will I not be able to take it into retirement? Someone told me that if I had been with TRICARE all these years, that somehow I was already considered vested in a federal health care insurance and could switch over to BC/BS and take the health insurance into my retirement. Is that true? Or do I need to actually work for five more years?
Q. I am 50, have 20 years under FERS and am thinking of retiring in six years when I reach my MRA of 56. If I do this, will I get health insurance coverage right away? Also, can I retire at 56 but delay retirement payments until 60 (or is it 62?) so I can avoid the 5 percent-per-year reduction in the payout? My main concern is keeping health insurance in place as soon as I retire at 56 — I can afford to delay the payout.
Q. I am a federal retiree and have the standard BC/BS coverage for my spouse and myself, plus Medicare Parts A and B. Our only out-of-pocket expenses with these plans are co-pays for prescriptions. Other federal retirees tell me I am over-insured and should drop Medicare Part B.
If I did this, would I still have the same coverage I have now, or would I then have out-of-pocket expenses?
Q. I have a postponed retirement. When I start my annuity at age 62, must I enroll in Federal Employees Health Benefits at startup or may I enroll at a later date?
Q. Regarding carrying health insurance into retirement at age 60 when one has had a break in service: I began full time with the federal government at age 30 in 2005 but would like to change careers in my mid-40s and become a science and math teacher.
I read that I need to have the last five years covered under FEHB to carry health insurance into retirement. Does this apply if I have fewer than 30 years of service? Can I become a teacher at 44, then return to federal service at 55 and expect to have health insurance at 60?
Q. I will have been a federal employee for five years on Aug. 31. I will be 61 years old. I would like to leave federal service effective on that date. Will I be entitled to a pension? If so, how do I determine the amount. What is the financial impact if I wait to retire until August 2014 when I am 62?
Q. I am 57 and a recent CSRS retiree. My husband is 67 and receives Social Security. He has Medicare Part A and is covered under my Federal Employees Health Benefits insurance plan. He is in the eight-month period after my retirement to enroll without penalty in Medicare Part B. Can he suspend his coverage in the FEHBP to enroll in a Medicare Advantage plan? Then I could change my FEHBP enrollment to self-only, which would reduce our insurance costs. Or is suspension of FEHB only an option for annuitants?
A. He can’t suspend his coverage under the FEHB program. However, during the next open season, you could change from self-and-family coverage to self-only. If, in the future, you would like to switch back to self-and-family coverage, you could do that during an open season.
Q. I am a retired federal employee with Kaiser Permanente standard health coverage. My co-pays are low, as are my prescription drugs. Kaiser offers a Medicare Plus plan I can enroll in, but I have to have Medicare Part B to qualify. My Federal Employees Health Benefits premiums would not increase and they advertise lower deductibles, I assume, because they would be able to bill Medicare for some of the costs of care. It doesn’t seem that enrolling in Medicare Part B when I turn 65 in a few months is worth the extra premium.
At some point in the next few years, I may move to an area where Kaiser is not available. If I have to switch to another FEHB plan like Blue Cross or another HMO, will it be more financially advantageous to have Medicare Part B if their coverage for co-pays and drugs are not as good as Kaiser? I would hate to have to enroll in Medicare Part B a few years down the road and pay the extra premium penalty when I could enroll now at lower cost. What do you think?
Q. My husband died at age 51 in 2000. He worked 28 years for USPS, plus four years in the military, for 32 years (he paid no Social Security taxes for the 28 years in USPS). I have received widow’s death benefit annuity payments since his death, in addition to purchasing the USPS medical insurance plan. I worked full time in the medical profession until his death and have worked part time since 2000. I would like to take my Social Security at age 62 (in 3 years). Am I still eligible to receive the USPS death benefit annuity (and insurance option) once I start collecting my Social Security?
Q. My wife just resigned from the U.S. Forest Service. She is 44 with more than 20 years of service. Did she lose all of her retirement, or is she still eligible to receive a portion at the reduced rate of 5 percent?
She was always in a position covered under firefighter retirement, eligible at 50 to retire. Also, is she still eligible for health benefits?
Q. I understand that when you retire, Medicare is your primary and federal insurance is your secondary. Will federal insurance still pay for prescription drugs even if you do not have a plan under Medicare?
Q. If I have 20 years of federal service (including more than 15 in the foreign service) but I haven’t turned 50, can I retire but defer receipt of my benefits/pension until I am eligible at age 50? For example, an employee is 47 years old and has completed 20 years of federal service. Can that employee leave the service and still receive full retirement benefits beginning at age 50?
Q. I’m a 68-year-old Postal Service employee under FERS. I wanted to retire on or about May 10 because I began my postal career as a regular carrier on May 10, 2009. I purchased the Blue Cross/Blue Shield Basic medical insurance as soon as the open season began in 2009. Now someone tells me that to continue into retirement with the BC/BS medical insurance, I should have signed up for the medical insurance immediately when I became a regular carrier in May 2009. I thought I needed to wait until the open season. Can I still retire on or about May 10, or do I have to wait until 2014 to get in under the five-year rule to continue my BCBS medical insurance?