Ask The Experts: Retirement

By Reg Jones


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Q. My husband has been declared disabled and begins Medicare A and B on Jan. 1. I am a current federal employee with plans to retire in about six years. Will my husband’s Medicare be primary for him, or will my Blue Cross/Blue Shield? I called BCBS to inform them of him becoming Medicare eligible, and they told me I would have to call back in November. I then asked if they pay what Medicare doesn’t, and they said they will be the primary for my husband. I don’t understand this and am wondering why.

A. Medicare will be primary for your husband and BCBS will be secondary. On the other hand, you will continue to be exclusively covered by BCBS. To find out how Medicare and BCBS will interact, check your BCBS benefits brochure.

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Federal retirees and health care payout limits

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Q: I am a 69-year-old federal retiree covered by a Blue Cross/Blue Shield Standard Option 105 health plan as well as Medicare Part A. I recently spoke with Blue Cross about reimbursement levels for doctor care when I received a bill from my internist for $400 and Blue Cross paid  $100. According to Blue Cross, I was responsible for the remaining $300 because Congress had passed rules (they may have meant that the Office of Personnel Management generated a rule, I am not sure) that limited the amount they could reimburse Medicare patients for a given procedure. When I checked with OPM, they said that the doctor could only charge me 115 percent of the Medicare level.

I could not get a clear answer from Blue Cross or OPM: Does this mean that any doctor I go to cannot charge me more than 115 percent of the base Medicare amount? What about doctors who do not participate in Medicare? When I asked Medicare, they said that a doctor can charge you more than the 115 percent if you sign a special contract agreeing to pay his bill in full; however, this measure is related to Medicare Part B, not Blue Cross. Before I argue with my internist about the invoice, I would like to know what the law says regarding federal retirees.

A: The rules governing in-patient hospital charges, physician charges, and Federal Employees Health Benefit benefit payments are found in the Code of Federal Regulations 5 CFR 890, Subpart I, beginning at Section 890.901. That document is available here.

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Limits to medical charges for non-Medicare providers

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Q: My wife and I are federal retirees and annuitants. We continue to enroll in the CareFirst Blue Cross/Blue Shield standard option. We do not have Medicare Part B. The Blue Cross 2010 Plan Booklet and several explanation of benefits from Blue Cross explain that by law, physicians who do not accept Medicare can only charge us up to 115 percent of what Medicare allows. The law applies to federal retirees and annuitants without Medicare Part B. Please confirm that what I summarized above is correct.

A: What you read on Page 23 of your plan brochure is correct.

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Medicare-related health plan options

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Q: The 2011 open-enrollment season will to intoduce a voluntary sub-option for annuitants who receive Medicare Part B. Can you give me an update on this Office of Personnel Management proposal? Will all the participatng plans offer this, especially Blue Cross/Blue Shield?

A: On April 7, OPM issued its annual call letter to plans participating in the Federal Employees Health Benefits program. In the letter, it encouraged them to propose “pilot programs wherein participating carriers offer a sub-option for Medicare-eligible annuitants as an alternate choice within their existing option(s). The sub-option may include premium pass-through accounts to be used solely for plans paying some or all of Medicare Part B premiums. The uniform contribution amount should provide an adequate incentive for eligible members to participate, but need not represent the full amount of Medicare Part B premiums. Individual Medicare premium amounts may vary based on consumer choice, penalties for failure to enroll in Medicare at the first opportunity, or increased premiums based on means testing.”

Responses to the call letter aren’t due until May 31. Whether any plans will elect to propose pilot programs is unknown at this time; if they do, it remains to be seen whether any of them would meet OPM’s criteria.

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Coverage gap for children over 22

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Q: We are on the federal Blue Cross/Blue Shield plan, and our son will turn 22 evidently before the extension comes into effect. I understand that he gets a month of courtesy coverage, which would expire on Dec. 22. So, what do we do for the additional nine or 10 days to keep him covered?

A: He will be offered an opportunity to continue his coverage under the Temporary Continuation of Coverage provision in the current law. The cost of that coverage would be 100 percent of the monthly premium, plus an additional 2 percent for administrative costs. Note: The Office of Personnel Management is working with Congress to amend the law to allow dependents such as your son to be covered sooner than Jan. 1, 2011. If that happens, you won’t have a problem.

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Blue Cross and Blue Shield after retirement

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Q: I am considering retiring, but need to know whether there is a specific form I must complete in order to continue my Blue Cross and Blue Shield insurance after retirement? I have had BCBS for over 5 years.

A: No special form is required. Your coverage will continue seamlessly without your doing anything other than your checking the box confirming your eligibility on the Application for Immediate retirement: Standard Form 2801 (Civil Service Retirement System) or 3107 (Federal Employees Retirement System).

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