Posted on Thursday, 5th November 2015 by

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The 2016 plan brochures are now available online at OPM.  I ordered 6 plan brochures through OPM’s FEHB Open Season Online service on Monday. I requested hard copies so I can sit down and review them offline. You can also view them online. This year has generated many more questions due to the new Self Plus One option and the fact that health care costs are generally increasing while our annuities are decreasing due to inflation and no 2016 COLA. Even with escalating costs our FEHB Health Care Program is still an excellent benefit.

A number of plans are dropping out of the program in 2016. You will have to select another plan if your plan is withdrawing from the FEHB program. Some Restricted Fee for Service plans, only open only to specific individuals, are not included in the 2016 guide. If you are enrolled in a restricted plan review the plan brochures for benefit and premium information.

It was brought to my attention that on page two of this year’s Open Season Benefits Guide it states that your spouse can continue coverage after the annuitant dies only if you have self and family coverage. The brochure states “While you can cover your spouse on a family enrollment during your lifetime, in the event of your death, your spouse may continue enrollment in the FEHB Program as your survivor only if you are enrolled in self and family coverage at the time of death, and you elected to provide a survivor benefit for your spouse.”

I called OPM and talked with Donna Douglas, an OPM customer service representative. She stated that the brochure needs to be updated and your spouse will be covered if you are enrolled in either a family plan or in the self plus one option when the annuitant dies and the spouse will automatically be switched to the self only option under your current plan.

Nicholas, another newsletter reader stated that he couldn’t find where he could pay his FEHB plan premiums directly because next year his annuity will not be enough to continue premium deductions. He didn’t want to switch to a lower cost plan. According to OPM, “if your monthly annuity payment is less than the monthly premium for the plan you want, you may pay your premium directly. You can request information on electing this payment option through Open Season Online or Open Season Express”.

Couples now enrolled in a family option are not automatically changed to the Self Plus One option. You must elect this new option if desired and make the change during open season. My previous articles titled FEHB Self Plus One – A Major Disappointment, and FEHB Cost Savings and our New 2016 Leave Chart provide additional information for the new Self Plus One option.

Many of your questions will be answered in this year’s Open Season Health Benefit Guide that you will receive shortly or you can download a copy at https://retireefehb.opm.gov/Annuitant/ after you register. I downloaded my copy earlier this week.

Request a Retirement Benefits Summary & Analysis. Includes projected annuity payments, income verses expenses, FEGLI, and TSP projections.

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The information provided may not cover all aspect of unique or special circumstances, federal regulations, medical procedures, and financial information are subject to change. To ensure the accuracy of this information, contact relevant parties and ask them to review your official personnel file and circumstances concerning this issue. Retirees can contact the OPM retirement center. Our article is not intended nor should it be considered investment advice and our articles and replies are time sensitive. Over time, various dynamic economic factors relied upon as a basis for this article may change. The advice and strategies contained herein may not be suitable for your situation and this service is not affiliated with OPM or any federal entity. You should consult with a financial, medical or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Last 5 posts by Dennis Damp

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    Posted in ANNUITIES / ELIGIBILITY, BENEFITS / INSURANCE, FINANCE / TIP, RETIREMENT CONCERNS, SOCIAL SECURITY / MEDICARE, SURVIVOR INFORMATION | Comments (10)


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    10 Responses to “FEHB Open Season Clarifications”

    1. Bhushan Gupta Says:

      In view of Steep increases in Medicare B premiums I am seriously thinking of dropping Medicare part B.
      I understand Nursing home coverage is provided under part A. Does one have to have part B for Blue cross Standard option to cover the nursing home deductible 157.50 for 9 days.
      What are the other benefits one loses by dropping medicare part B. Can you point to a calculatorto help with this decision

    2. Dennis Damp Says:

      Part B covers doctors visits and Part A hospital stays. Section 9 of your Blue Cross Blue Shield 2016 Guide covers coordinating benefits with Medicare and other coverage. It starts on page 135 and discusses how Medicare impacts your FEHB coverage. You can also contact BCBS and ask them specific questions regarding coverage if you can’t find it in the guide. Here is a link to a series of articles that I wrote about this subject that you will find helpful. Please share these links with others in your organization that will benefit from this information. Go to http://www.federalretirement.net/medicare.htm and under the menu title “Should I Enroll in Medicare” select any of the 5 articles that interest you under this heading. These articles should help. There is a FEHB Comparison Tool available on http://retireefehb.opm.gov that does provide a detailed comparison including what each plan covers if you are enrolled in Medicare. I have Blue Cross Basic and did opt to take Part B after much deliberation mostly because many retiree health care plans are now requiring participants to sign up for Part B and there is a 10% penalty for each year you delay signing up. Currently our FEHB plans do not require us to sign up but with our budget crisis you never know what changes are coming down the road. I will say that since signing up I had one operation and numerous doctors visits with zero out-of-pocket costs.

    3. brit Says:

      Hi please help me. My husband and I have Medicare and our MHBP is our supplemental insurance for both of us. I do not know whether we should change it to the self Plus One? Is there an advantage? Our coverage now seems fine but as my husband has dementia and I am now in charge of all this stuff I am totally worried about what to do 🙁 I have read alot but nothing tells me which is best. Please help. Thanks

    4. Bhushan Gupta Says:

      BAL 15-209 issued on October 20 ,2015 clarifies the issue of survivor Annuitant eligibility to continue coverage in case of death of Annuitant.
      “For surviving family members to continue FEHB coverage after an employee’s or annuitant’s death, the enrollee must have been enrolled in Self Plus One or Self and Family at the time of death. If the enrollee was enrolled in Self and Family, at least one family member must be eligible for a survivor annuity. If the enrollee was enrolled in Self Plus One, the designated family member under the Self Plus One enrollment must
      be eligible for a survivor annuity. If the family member designated under Self Plus One is
      not eligible for a survivor annuity, the enrollment cannot continue and terminates on the last day of the pay period in which the enrollee dies.”

    5. Bob Says:

      Currently retired FEHB BC/BS and want to try Medicare advantage plan to cut cost, what are the rules to change back to FEHB – I read somewhere you must sign up to advantage plan first then you stop FEHB plan cost- then you may return to FEHB during open season if you want coverage again -Thanks

    6. Bears Fan Says:

      When I retired from civil service about a decade ago, I asked several of my colleagues how advantageous it would be to add Medicare to my health insurance to be well protected. Those whom I asked had no answers, since Medicare was irrelevant to their situations. One of them advised me to call someone at CMS, whom I was unable to contact. Other information I have read suggested that Medicare and my FEHP plan will complement each other. I joined Medicare Part A at some point, but not Part B.

      Down the road now, I am unconvinced that, in my situation, Medicare B will be of any benefit to me. However, as a lifetime working class person, meaning by that, a limited pension income of about 3k per month, and because my wife has a variety of health issues, I am forced to ask the same question again, this time publicly.

      Is Medicare always an advantage to a household that is already medically insured? Why would we need Medicare if we have an FEHP plan? Why should we keep our FEHP after (if) we enroll in Medicare?

      I pay $320.00 every month for my FEHP medical insurance (it will be $352.00 in 2016). If I join Medicare B, I would have to cough up about $170.00, or thereabout, to insure myself and about $140.00 for my wife. In other words, with a $3,000.00 monthly income my combined health care cost (FEHP/Medicare) will total $650.00, an amount I will hardly be able to afford.

      On a monthly basis, our FEHP outpatient deductibles are much less than $320.00, which is what I will pay if we join Medicare Part B. My pesky FEHP insurance keeps remiding me that I will not have to make FEHP co-payments if I join Medicare B. They make annoying inquiries about this subject from time to time.

      I have been unable to speak to an OPM person about this subject. Their general online response is that it is usually beneficial to have Medicare available, along with my FEHB insurance. If push comes to shove I may have to join Medicare (mainly because of my wife’s health condition), but not without making a financial sacrifice. I will appreciate your opinion/advice on this subject. Thank you

    7. Dennis Damp Says:

      All are excellent questions and I discuss the Medicare options in detail in a number of articles I wrote. Here are links that will help you make a decision. However, since you didn’t elect Medicare Part B when you first were eligible they tack on a 10% penalty for each year you delay. Here is a list with links to articles that will answer your questions:

      Should I enroll in Medicare
      Medicare and FEHB Options – What Will You Do When You Turn 65? (Part 1)
      What to Consider Before Enrolling in Medicare B (Part 2)
      Should You Change to a Lower Cost FEHB Plan When You Sign Up For Medicare (Part 3)
      Medicare Part B and FEHB Update (Part 4)

    8. Dennis Damp Says:

      If you are retired you can register and make this change online at http://www.retireefehb.opm.gov or you can call Open Season Express at 1-800-332-9798 according to this years Open Season Health Benefits Guide. If you are still employed go through your personnel or HR office or use your agencies online services to make the change.

    9. Dennis Damp Says:

      If you cancel FEHB you can’t rejoin later. You can suspend your FEHB coverage if you elect to go to another provider and then at a later day if desired you can rejoin the FEHB program. Here is a link that describes how to suspend coverage: http://www.federalretirement.net/fehb.htm#Canceling_Coverage_in_Retirement

    10. Dennis Damp Says:

      There are three MHBP plans and I assume you are in the Standard Self and Family option. The Standard Self and Family Option will cost you $352 per month in 2016 while the Self Plus One plan will cost you $383.00, $31 more per month for the same coverage. You do not have to change to a Self Plus One plan so if you are satisfied with your plan and have the Standard Self and Family plan it would be less expensive for you to remain in that option. Several of the FEHB plans are charging more for the Self Plus One Option. You could request brochures for a number of plans such as the GEHA, Blue Cross and Blue Shield and others to determine the best plan based on your needs. You could end up with a lower cost option. You can request plan brochures from OPM’s retiree FEHB site or call 1-800-332-9798. It is difficult getting through to the toll free number right now however the online service is easy to use and sign up for.