2. Tammy Flanagan Senior Benefits Director National Institute of Transition Planning, Inc.

3. FEHBP ◦ Public Law 86-382 ◦ Largest group insurance in world ◦ Covers 8 million enrollees ◦ 200+ choices ◦ Open Seasons ◦ OPM Oversight www.narfeny.org

4. 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

5. Medicare for Federal employees  P.L. 97-248 ◦ Tax Equity and Fiscal Responsibility Act of 1982  January 1, 1983 Who would benefit from this change? this change?

6. 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.

7.  1988 ◦ Medicare Catastrophic Coverage Act  1989 ◦ Medicare Catastrophic Coverage Act Repealed  1997 ◦ Balanced Budget Act of 1997 ◦ Medicare + Choice (Medicare Part C or Medicare Advantage)  2003 ◦ Medicare Prescription Drug, Improvement and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

8. 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

9. 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

10. 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% coverage Days 21 – 100: covered all but $144.50 / day After 100 days: no coverage

11.  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

12.  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

13. 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

14. 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

15. 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

16. FEHBP (Kaiser) Medicare

17. FEHBP – BC/BS Medicare

18. 2013 Compare FEHBP Plans

21. PlanSelfFamily 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

22. PlanSelfFamily 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

23. PlanSelfFamily 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

24. Medicare Enrollment Period Publication

28. Questions? Medicare and You 2013 Publication 3