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FEHB and Medicare
 

FEHB and Medicare

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    FEHB and Medicare FEHB and Medicare Presentation Transcript

    • 1
    • Q. Do I Have to Take Part B Coverage?Q. What Happens If I Dont Take Part B as Soon as Im Eligible?Q. How Much Does Part B Coverage Cost?Q. Does the FEHB Program Offer Medigap Policies?Q. Do I Need a Medigap Policy When I Have FEHB and Medicare Coverage?Q. Does My FEHB Plan or Medicare Pay Benefits First?Q. When is My Medicare Plan The Primary Payer?Q. When is My FEHB Plan The Primary Payer?Q. If I Have FEHB, Medicare and other Coverage, Which Is Primary?Q. If I Work Past Age 65, Is FEHB Still Primary?Q. Do My FEHB Premiums Change When Medicare Becomes Primary?Q. Will My FEHB Fee-For-Service Plan Cover All My Out-Of Pocket Costs Not Covered byMedicare?Q. Must I Use My FEHB HMOs Participating Providers When Medicare is Primary?Q. If I Go to My FEHB HMOs Providers, Do I Have to File a Claim With Medicare?Q. Do I Have to Pay Medicares Deductibles and Coinsurance When I Use My FEHB HMOsDoctors?Q. Do I Have to Pay My FEHB HMOs Copays" Do I Have to Pay My FEHB HMOs Copays? 2
    • Q. Do I Have to Take Part B Coverage? A. You dont have to take Part B coverage if you dont want it, and your FEHB plan cant require you to take it. There are some advantages to enrolling in Part B: • You must be enrolled in Parts A and B to join a Medicare Advantage plan. • You have the advantage of coordination of benefits (described later) between Medicare and your FEHB plan, reducing your out-of-pocket costs. • Your FEHB plan may waive its copayments, coinsurance, and deductibles for Part B services. • Some services covered under Part B might not be covered or only partially covered by your plan, such as orthopedic and prosthetic devices, durable medical equipment, home health care, and medical supplies (check your plan brochure for details). • You may go outside of the plans network for Part B services and receive reimbursement by Medicare (only when Medicare is the primary payer) If you are enrolled in an FEHB HMO. Back to MENU 3
    • Q. How Much Does Part B Coverage Cost? A. The premium for Part B coverage is determined by Medicare. The monthly premium amount is available in the "Medicare & You" handbook produced by the U.S. Centers for Medicare and Medicaid (CMS) and is also available on the Medicare website at www.medicare.gov. Before 2006, the Government generally funded about 75 percent of the total Part B premium. Starting in 2007, higher income beneficiaries began to receive a reduced subsidy which was phased in by 2009. At that time, subsidies for higher income beneficiaries ranged from about 65 percent to 20 percent of the total premium. This change will affect only about four percent of all Medicare beneficiaries. The Part B premiums for 2012 range from $99.90 to $319.70 and will be adjusted annually. Back to MENU 4
    • Q. What Happens If I Dont Take Part B as Soon as Im Eligible? A. If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up10 percent for each 12 months that you could have had Part B but didnt take it. You will pay the extra 10 percent for as long as you have Part B. If you didnt take Part B at age 65 because you were covered under FEHB as an active employee (or you were covered under your spouses group health insurance plan and he/she was an active employee), you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working or are no longer covered by the group plan. You also can sign up at any time while you are covered by the group plan. Back to MENU 5
    • Q. Does the FEHB Program Offer Medigap Policies? A. FEHB is not one of the standard Medicare supplemental insurance policies known as Medigap or Medicare SELECT policies. However, FEHB plans and options will supplement Medicare by paying for costs not covered by Medicare, such as the required deductibles and coinsurance, and by providing additional benefits not provided under Medicare A and B, such as prescription drugs. Back to MENU 6
    • Q. Do I Need a Medigap Policy When I Have FEHB and Medicare Coverage? A. No, you dont need to purchase a Medigap policy since FEHB and Medicare will coordinate benefits to provide comprehensive coverage for a wide range of medical expenses. Back to MENU 7
    • Q. Does My FEHB Plan or Medicare Pay Benefits First? A. Medicare law and regulations determine whether Medicare or FEHB is primary (that is, pays benefits first). Medicare automatically transfers claims information to your FEHB plan once your claim is processed, so you generally dont need to file a claim with both. You will receive an Explanation of Benefits (EOB) from your FEHB plan and an EOB or Medicare Summary Notice (MSN) from Medicare. If you have to file with the secondary payer, send along the EOB or MSN you get from the primary payer. Back to MENU 8
    • Q. When is My FEHB Plan The Primary Payer? A. Your FEHB Plan must pay benefits first when you are an active Federal employee or reemployed annuitant and either you or your covered spouse has Medicare. (There is an exception if your reemployment position is excluded from FEHB coverage or you are enrolled in Medicare Part B only.) Your FEHB Plan must also pay benefits first for you or a covered family member during the first 30 months of eligibility or entitlement to Part A benefits because of End Stage Renal Disease (ESRD), regardless of your employment status, unless Medicare (based on age or disability) was your primary payer on the day before you became eligible for Medicare Part A due to ESRD. Your FEHB Plan must also pay benefits first when you are under age 65, entitled to Medicare on the basis of disability, and covered under FEHB based on you or your spouses employment status. Back to MENU 9
    • Q. When is My Medicare Plan The Primary Payer? A. Medicare must pay benefits first when you are an annuitant, (unless you are a reemployed annuitant, see above), and either you or your covered spouse has Medicare. (This includes Federal judges who retired under title 28, U.S.C., and Tax Court judges who retired under Section 7447 of title 26, U.S.C.) Medicare must pay benefits first when you are a former Federal employee receiving Workers Compensation and the Office of Workers Compensation has determined that youre unable to return to Duty, except for claims related to the Workers Compensation injury or illness. If Medicare was the primary payer prior to the onset of End Stage Renal Disease, Medicare will continue to be primary during the 30-month coordination period. However, if Medicare was secondary prior to the onset of End Stage Renal Disease, it will continue to be secondary until the 30-month coordination period has expired. After the 30-month coordination period has expired, Medicare will be primary regardless of your employment status. Back to MENU 10
    • Q. If I Work Past Age 65 , Is FEHB Still Primary? A. Your FEHB coverage will be your primary coverage until you retire. Back to MENU 11
    • Q. If I Have FEHB, Medicare and other Coverage, Which Is Primary? A. Since you are retired but covered under your working spouses policy, your spouses policy is your primary coverage. Medicare will pay secondary benefits and your FEHB plan will pay third Back to MENU 12
    • Q. Do My FEHB Premiums Change When Medicare Becomes Primary? A. No. You will continue to pay the same premiums, unless you change to another plan or option. Back to MENU 13
    • Q. Will My FEHB Fee-For-Service Plan Cover All My Out-Of Pocket Costs NotCovered by Medicare?A. Not always. A fee-for-service plans payment is typically based on allowable charges, not billed charges. In some cases, Medicares payment and the plans payment combined will not cover the full cost.Your out-of-pocket costs for Part B services will depend on whether your doctor acceptsMedicare assignment. When your doctor accepts assignment, you can be billed only for thedifference between the Medicare-approved amount and the combined payments made byMedicare and your FEHB plan.When your doctor doesnt accept assignment, you can be billed up to the difference between 115percent of the Medicare approved amount (limiting charge) and the combined payments madeby Medicare and your FEHB plan.Medicare will pay its share of the bill and your FEHB plan will pay its share. Some services, suchas medical supplies and some durable medical equipment, do not have limiting charges. Back to MENU 14
    • Q. Must I Use My FEHB HMOs Participating Providers When Medicare is Primary?A. If you want your FEHB HMO to cover your Medicare deductibles, coinsurance,and other services it covers that are not covered by Medicare, you must use yourHMOs participating provider network to receive services and get the requiredreferrals for specialty care. Back to MENU 15
    • Q. If I Go to My FEHB HMOs Providers, Do I Have to File a Claim With Medicare?A. No. If needed, your HMO will file for you and then pay its portion afterMedicare has paid Back to MENU 16
    • Q. Do I Have to Pay Medicares Deductibles and Coinsurance When I Use My FEHBHMOs Doctors?A. Your HMO will pay the portion not paid by Medicare for covered services. Back to MENU 17
    • Q. Do I Have to Pay My FEHB HMOs Copays" Do I Have to Pay My FEHBHMOs Copays?A. Usually, you will still have to pay your FEHB HMOs required copays. Some HMOs waive payment of their copays and deductibles when Medicare is primary.Check your FEHB plans brochure for details.For additional information about Coordination of Benefits please visitMedicares website at www.cms.hhs.gov/COBGeneralInformation/ Back to MENU 18