Posted on Saturday, 12th November 2016 by

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Each year active federal employees and annuitants must obtain hard copies of plan brochures and general information about open season.  I review plan changes each year and confirm that our doctors and medical facilities are still on the provider list. OPM does send out an informative Open Season Health Benefits guide to all participants that discusses open season changes, sign up procedures, and available plans and costs for your area.  Federal employees can review and download copies of plan brochures from OPM, obtain brochures through their agency’s HR office, their office’s point of contact, or direct from FEHB providers.

I register in November online at OPM’s FEHB Open Season Online to download the Open Season Health Benefits Guide and to request hard copies of plan brochures of interest.  This site is exclusively for retirees.  Retirees can also call the Open Season Express line at 1-800-332-9798 to request brochures or change enrollment.

I was traveling at the beginning of November and when I went online to sign up, which you have to do each year, the sign up prompt asked for my CSA number. Fortunately, I had my Retirement Services Reference Card with me which lists my CSA number. If you can’t find your number you can use the email address that you listed on the service if you signed up the previous year.

I requested several plan brochures to compare and typically request the lowest cost and highest cost plan brochures so that I can discuss the differences in my articles.  This year, like most, the premiums vary considerably between plans.  I downloaded the Open Season Health Benefits Guide for Pennsylvania. The monthly Non-Postal Premiums varied for a Self Plus One enrollment from a low of $206.03 for the NALC – Value Option (Nationwide Fee-For-Service Plan) to a high of $2,377.09 for the Aetna Open Access – High (HMO)!  I questioned the Aetna plan monthly premium so I reviewed their brochure online to confirm the cost.  I even reviewed the summary of benefits but couldn’t easily determine why the costs are so high.

My wife and I are enrolled in the GEHA Standard Self Plus One plan that will cost us $250.90 per month in 2017. I changed to GEHA when I turned 65 several years ago because it is lower cost and Medicare is our primary coverage.  Also, GEHA covers both PPO and non PPO providers even in our low cost standard plan so we can go to about any doctor for the most part and still be covered.  GEHA has waived all copayments, coinsurance, and deductibles since enrolling in Medicare A and B except for prescription drugs.

There were several changes to our plan including a change to the network of preferred hospitals and physicians in Pennsylvania from the HealthAmerica network to Aetna Signature Administrators.  GEHA updated their online provider’s search tool and I was able to confirm that all of our doctors and the hospital networks we use are on the list. The only one that fell through the crack was our dentist and I will call them early next week to see if he has been added yet.  This shouldn’t be an issue for us because we also have MetLife dental coverage and they covered most of our dental costs this past year. We intend to stay with our current plan.

I’ve been with MetLife Dental for many years and they do cover a lot of the costs that GEHA doesn’t pick up. My wife had a root canal this year and it only cost her $250 much less than what it would have cost without the coverage.  She also had a tooth extraction that we didn’t pay any out-of-pocket expenses. The one thing I noticed is that my MetLife card is almost unreadable and I had to request a replacement from them last week.

For those who have both Medicare and FEHB coverage for the most part Medicare becomes your primary provider. However, that being said, there are exceptions to this rule.  Bill, one of our readers, stated that in his case FEHB remained his primary provider.  According to Bill, “Your column states that when I retire, Medicare becomes my primary insurance and FEHB is secondary.  That is correct if I am the one carrying the insurance.  My wife and I elected to have her carry the insurance as an active federal employee when I retired to take advantage of the health savings plan.  Therefore, FEHB remains my primary with Medicare as secondary.” There are circumstances where this can be the case.

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Disclaimer: Opinions expressed herein by the author are not an investment or benefit recommendation and are not meant to be relied upon in investment or benefit decisions. The author is not acting in an investment, tax, legal, benefit, or any other advisory capacity. This is not an investment or benefit research report. The author’s opinions expressed herein address only select aspects of various federal benefits and potential investment in securities of the TSP and companies mentioned and cannot be a substitute for comprehensive investment analysis. Any analysis presented herein is illustrative in nature, limited in scope, based on an incomplete set of information, and has limitations to its accuracy. The author recommends that retirees, potential and existing investors conduct thorough investment and benefit research of their own, including detailed review of OPM guidance for benefit issues and for investments the companies’ SEC filings, and consult a qualified investment advisor. The information upon which this material is based was obtained from sources believed to be reliable, but has not been independently verified. Therefore, the author cannot guarantee its accuracy. Any opinions or estimates constitute the author’s best judgment as of the date of publication, and are subject to change without notice. The author explicitly disclaims any liability that may arise from the use of this material.

 

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