The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Is the Medicare Part B late enrollment penalty statutory or regulatory?”

Kevin’s response:

The Part B late enrollment penalty can be found in the general and permanent laws of the United States, found here.

The specific location is Title 42 – The Public Health And Welfare, Chapter 7 – Social Security, Subchapter XVIII – Health Insurance For Aged and Disabled, Part B – Supplementary Medical Insurance Benefits for Aged and Disabled, Sec 1395r – Amount of Premiums for Individuals Enrolled Under This Part.

”…the monthly premium…shall be increased by 10 percent of the monthly premium so determined for each full 12 months (in the same continuous period of eligibility) in which he could have been but was not enrolled.”

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Are three two separate payments or two payments in one? I know there is a Part B payment, but didn’t know they attached a payment called IRMAA to the Part B payment.

Boy, this is rough on a retiree’s fixed income.”

Kevin’s response:

If you’re an individual tax filer and your modified adjusted gross income is above $103,000 or if you’re a joint tax filer with modified adjusted gross income above $206,000, you’ll be subject to an income related monthly adjustment amount, or IRMAA. In the first income tier of IRMAA, you’ll pay an additional $69.90/month for Part B and an additional $12.90/month for Part D. If you’re subject to IRMAA it will be added to the Part B premium.

Your choice of plans can help mitigate the additional Part B premium. Many, but not all, FEHB plans will eliminate out-of-pocket costs for doctor and outpatient services, and there are a couple of FEHB plans that offer a partial Part B premium reimbursement. Also, some MA plans offered by FEHB plans have $0 out-of-pocket costs for approved medical services from providers that accept Medicare and the plan, besides prescription drugs. Most of the MA plans offered by FEHB plans also include generous Part B premium reimbursement. The combination of $0 out-of-pocket costs (besides prescription drugs) and Part B premium reimbursement, help make MA plans offered by FEHB plans the lowest cost plan type for most federal annuitants.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“I have gotten conflicting and complicated information regarding does FEHB include/offer a Medicare Advantage option as a FEHB plan?

I have called OPM three times. Their advice is to call Medicare.

Medicare has no information on what plans are available to FEHB. Their advice is to call the plan. The plan says they do offer Medicare Advantage coordination, but it is offered with any plan, not a specific Medicare advantage plan (Aetna and BCBS), with some rebate of Part B premium and hoops regarding retiree services, etc., in an endless loop of ‘not my problem.’ Yet I see online where, since 2021, this has been an option.

It seems to be more clear cut for the Postal Service people, which I am not. I am on disability retirement and SSDI. Do you have any information regarding Medicare Advantage coordination with FEHB?”

Kevin’s response:

There are some FEHB plans that offer a Medicare Advantage plan to their Medicare eligible enrollees.

National plans include Aetna Advantage, APWU High, GEHA High and Standard, MHBP Standard, NALC High, and SAMBA High and Standard.

In addition, depending on where you live, you might have access to Kaiser or United Healthcare options.

To learn more about Medicare Advantage plans offered by FEHB plans, go to section 9 of the official FEHB plan brochure or to the carrier website.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Am I to understand that Medicare is an integral part of retirement at age 65, even if a federal employee has an FEHB in retirement. Why is this?

Can the Medicare Part B be declined to avoid the high costs of the Part B premium and a potential IRMAA fee?Will the FEHB not be enough to cover all health care needs in retirement just as it did during active federal employee service?

Is there a comparison between having or not having Medicare Part B with an FEHB in retirement that one can distinguish to make a safe, informed decision on what to choose?The pros and cons, so to speak.”

Kevin’s response:

If you decide to not enroll in Medicare Part B, your FEHB plan will work the same way as it did as an active employee. You’ll continue to pay your FEHB plan member cost share for doctor and outpatient services.

There are three main reasons to consider enrolling in Part B.

1. Lower out-of-pocket costs – With Part B, many FEHB plans will waive out-of-pocket costs for doctor and outpatient services, and the deductible could also be waived, if your plan has one. Also, a couple of FEHB plans will reimburse a portion of the Part B premium.

2. Access to more doctors – With Part B you can go outside of your plan network and see any provider that accepts Medicare. You may be subject to the annual Part B deductible of $240 and 20% cost of service.

3. Medicare Advantage – Having Part B gives you the option to enroll in Medicare Advantage plans offered by FEHB plans. Some of these MA plans have $0 out-of-pocket costs for approved health care services from providers that accept Medicare and the plan, besides prescription drugs. Also, some MA plans will reimburse a portion of the Part B premium. The combination of $0 cost health care services (besides prescription drugs) and Part B premium reimbursement make MA plans offered by FEHB plans the lowest cost plan type for most federal annuitants.

The main reason to not consider enrolling in Part B is the cost of the extra premium. For federal annuitants that are not subject to IRMAA, adding Part B will most likely be worth it. Having Part B gives you the option to see doctors outside of the plan network and if you enroll in an FEHB plan that waives some out-of-pocket costs or consider MA plans offered by FEHB plans, you could see a reduction in your total healthcare spending.

For federal annuitants that are subject to IRMAA, most of the benefits of enrolling in Part B will erode by having to pay more. This is especially true if your income places you in the second tier or higher of IRMAA and you expect that level of income throughout your retirement.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Do I have to enroll in Medicare Part A? Is there a penalty for failure to enroll when I decide to finally do?”

Kevin’s response:

If you or a spouse has worked for at least 10 years, Medicare Part A will be premium free. There is no advantage of delaying enrollment for premium free Part A.

Many FEHB plans will waive their in-patient hospital costs when Part A is primary. Also, being enrolled in at least Part A will qualify you to enroll in Part D prescription drug plans.

If you don’t have enough work credits to qualify for premium free Part A, you’ll have to buy Part A if you decide to enroll. If you don’t buy it when you’re first eligible to enroll, your monthly premium may go up 10%. Also, you’ll have to pay the penalty for twice the number of years you could have had Part A but didn’t sign up. For example, if you miss 2 years you’ll have to pay the higher premium for 4 years.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“I became a Federal Employee under the FERS retirement program in the fall of 2010. I retired from the reserves prior to becoming a federal employee. I am now receiving my retirement benefits from the reserves, which includes Tricare and have suspended my FEHB.

My spouse turns 65 next spring (2025) and I will turn 65 in the fall. I am aware that in order to receive Tricare for Life, one would need to purchase Medicare Part B.

I am wondering if I activate my FEHB, can I waive Medicare Part B and still maintain my Tricare coverage either as Tricare for Life or Tricare Select? I think it would be a cost savings since the FEHB plan (Blue Cross Blue Shield) for my spouse and I would cost less than each of us paying Medicare premiums plus the IRMAA additional premiums.”

Kevin’s response:

In order to qualify for Tricare for Life, you would need to enroll in Medicare Part B. However, retired reserve members at the age of 60 can instead choose to enroll in Tricare Select.

With Tricare Select, your FEHB plan would be primary and Tricare Select would be secondary. You wouldn’t need to enroll in Part B to be covered by an FEHB plan and Tricare Select. This would save you the cost of the Part B premium and having both FEHB and Tricare Select coverage will help you save on out-of-pocket healthcare costs.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“During open season, can I elect to change to a non-FEHBP plan (for example, original Medicare with a supplement) and return into FEHBP during a following open season if needed?

Also, if I do so, may I still purchase dental & vision plans through FEDVIP?”

Kevin’s response:

During Open Season you can suspend your FEHB plan and enroll in a commercial MA plan. You would not have to pay an FEHB premium, only the Medicare Part B premium and any premium charged by the commercial MA plan. You would be able to re-enroll into an FEHB plan during any future Open Season, unless you involuntarily lose coverage or move out of the commercial MA plan’s service area, which would be a qualifying life event allowing you to re-enroll into an FEHB plan outside of Open Season.

Before considering this option, I encourage you to review MA plans offered by FEHB carriers. Many of them have generous Part B premium reimbursement and $0 for most health care expenses for approved care from providers that accept Medicare and the plan, besides prescription drugs.

You may find that MA plans offered by FEHB carriers offer more generous benefits than what can be found in the commercial MA marketplace.

If you’re eligible for FEHB, you’ll remain eligible for FEDVIP dental or vision plans even if your FEHB coverage is suspended.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Will I be able to keep Blue Cross Blue Shield under the new Postal health care plan?”

Kevin’s response:

OPM has released a list of conditionally approved PSHB carriers, found here.

BCBS is one of the conditionally approved PSHB carriers.

However, final PSHB plans for plan year 2025 will not be released until this fall.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Can you use your FEHB plan with traditional Medicare, or do have to sign up for a Medicare Advantage plan?”

Kevin’s response:

Yes, you can use Original Medicare (Parts A & B) with your FEHB plan, you’re not limited to just Medicare Advantage plans.Medicare Part A, which covers inpatient hospital, is premium free for most if you paid at least 10 years of Medicare taxes while you were working.

Medicare Part B, which covers doctor services, requires paying a premium. The Part B premium for 2024 is $174.70/month. Based on your income, you may be subject to an Income Related Monthly Adjustment Amount (IRMAA). Individual tax filers with annual income above $103,000 and joint tax filers with annual income above $206,000 are subject to IRMAA. In the first income tier, IRMAA adds an additional $69.90/month to the cost of Part B.

When you have Original Medicare and FEHB coverage, Medicare becomes primary and your FEHB plan is secondary. Some, but not all, FEHB plans will waive the deductible and out-of-pocket costs for doctor visits and outpatient services when you have Medicare. And, there are a couple of FEHB plans that offer a partial Part B premium reimbursement. To maximize having Medicare, you’ll want to find an FEHB plan that eliminates out-of-pocket costs when you have Medicare.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“I have read a lot about the special enrollment program, but nowhere have I found how to go about enrolling. Please clarify the steps.”

Kevin’s response:

As part of the new PSHB program, eligible USPS annuitants were notified by mail in March about the Medicare Part B Special Enrollment Period.

During the PSHB SEP, eligible annuitants and family members may enroll in Part B without paying a late enrollment penalty. The one-time PSHB SEP lasts until September 30, 2024.

To enroll in Part B you should complete the CMS-40B form, Application for Enrollment in Medicare Part B, and mail it with the copy of the notification letter in the return envelope you received in March. The return envelope must be postmarked by Sept. 30, 2024.

If you have misplaced the notification letter mailed to you, you can contact the PSHB Navigator Help Line at 833-712-PSHB or email retirementbenefits@usps.gov

Go to KeepingPosted.org for all the latest PSHB news.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com