Ask The Experts: Retirement

By Reg Jones

Medicare Part B

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Q. I am a Bureau of Prisons retiree with GEHA health insurance. Should I enroll in Medicare B? I know I don’t have to enroll in Medicare B, but would like to know the pros and cons of not enrolling. It seems the only entity that would benefit from that enrollment would be GEHA, or whichever health plan I enroll in, as it would automatically be deemed secondary with Medicare Part B as the primary, thereby avoiding paying the full cost of whatever medical procedure I might receive. If I sign up for Medicare B, won’t I be paying twice for the same services? If that is the case, why would I even consider enrolling in Medicare Part B? Am I missing something here?

A. The best place to find the pluses and minuses of enrolling in Medicare Part B will be found at www.opm.gov/health/medicare/index.asp.

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Primary vs. secondary insurance

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Q. I have been covered by my wife’s GEHA plan for the past 10 years, and I continue to be covered under her policy (as do our two kids; we are in a self and family plan). Two new variables are coming into play for my health care: 1) I will be eligible for Medicare coverage in two months; and  2) I just started receiving a federal annuity. (Note: I am eligible to receive Social Security but have not yet signed up).

I have two related questions:

1) If I continue to remain under my wife’s Federal Employees Health Benefits policy (assuming that I can), what happens if I sign up for Medicare? Which is the primary insurance, and is it more beneficial to have FEHB or Medicare as the primary insurance?

2) If I were to register for Medicare coverage (and if I am still under FEHB coverage via my wife), does it make sense to register for both Part A and Part B, or just Part A of Medicare? Insurance?

A. Because you are retired, Medicare would be primary and your FEHB coverage secondary. It doesn’t make any sense not to sign up for Medicare Part A because you’ve already paid for that benefit through payroll deductions. Whether you need to sign up for Part B is decision you’ll have to make. To get a better understanding of the relationship between the FEHB and Medicare, go to www.opm.gov/insure/health/medicare/index.asp

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Medicare

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Q. I am getting ready to enroll in Medicare. I have GEHA High Option Family Plan and was advised to change to GEHA Low Option Family Plan once I am enrolled in Medicare. I have the High Family Option because my spouse is ill and requires frequent medical attention.

A. The only way to know if that would be a good decision for you and your spouse would be to compare the benefits for each level of GEHA coverage and see how they would mesh with Medicare. If your spouse isn’t covered by Medicare, electing the low option might increase your out-of-pocket expenses.

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FEHB and Medicare

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Q. I retired from federal service in 2003, am still working and continued my Federal Employees Health Benefits upon retirement. When I turned 65 last September, I and my spouse opted for Medicare Part A only.

On a recent claim approved by the Government Employees Health Association, they sent a cover letter which stated: “Our records indicate that the member is a federal retired employee, and the patient is 65 (my spouse) or older and does not have Medicare Part B.  Therefore under the change in Federal Law (5 U.S.C. 8904(B)) we are required to allow no more than the Medicare fee schedule amount for services rendered 1/1/95 and thereafter.  The change in Federal Law makes the provider Medicare participation agreement binding.”

The provider did have a Medicare participation agreement, so GEHA reimbursed at the Medicare rate.

If the provider did not have a Medicare participation agreement, would this require GEHA to reimburse at the GEHA rate according to the FEHB contract?

I pay for FEHB/GEHA coverage, so why does a Medicare rate schedule apply when I do not have Part B?

A. If you do not have Medicare Part A, Part B or both, the law requires that your FEHB plan must base its payments on the equivalent Medicare amount set by Medicare’s rules for what Medicare would pay, not on the actual charge. For more information, pull out your plan brochure and look at the section titled, “When you are age 65 or over and do not have Medicare.”

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Adding vision coverage

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Q. I changed from GEHA high deductible to Blue Cross/Blue Shield Standard Family and would like to add one of the vision plans. When I called BEST, they told me this could only be done during open season. I thought this was like an addition to the Federal Employees Health Benefits plan. I realize these are stand-alone plans, and I haven’t had a life qualifying event. I just want to get a vision plan for the first time. Have I missed the boat until the next open season?

A. Yes, you’ve missed the boat. Unless you have a life qualifying event or are a newly hired employee, enrollment is only possible during the annual open season.

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Should I buy Medicare Part B?

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Q: I am a retired federal employee, almost 65 years old, and I have to decide whether to sign up for Medicare Part B. Whether I sign up or not, I will continue with the Federal Employees Health Benefits Plan (currently Government Employees Health Association, which has a maximum annual $5,000 out-of-pocket expense). The Part B decision seems to be one of costs versus benefits. I would pay about $1,400 per year for Part B and would save/eliminate most of my out-of-pocket expenses. I rarely spend more than about $1,000 a year in out-of-pocket expenses.
 
It’s almost impossible to predict how the future will go on costs for Medicare and the FEHPB or on required future services. But based on my analyses, it appears that it would be easier to select an FEHPB plan that has a low annual out-of-pocket expense, some of which are not significantly different than the cost of carrying GEHA. So, I am not seeing a lot of benefit for federal employees to sign up for Part B. Are there any statistics regarding how many otherwise-Medicare-eligible federal employees decide against signing up for Part B?

A: As far as I know, there aren’t any such statistics. Nor would knowing them be of any value in determining whether you should sign up for Medicare Part B coverage. Decisions like this are personal ones, based on what we know about our health, what we anticipate, and what we fear.

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