Posted on Tuesday, 10th November 2015 by

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This open season has created confusion for many especially issues concerning the new FEHB Self Plus One option.  OPM’s Open Season Health Benefits Guide has left many questioning whether or not they will leave their spouse without coverage when they die if they change to the Self Plus One option.  When I first discovered the discrepancy I called OPM and talked with Donna Douglas, an OPM customer service representative. She confirmed that your spouse will be covered if you are enrolled in a family plan or the self plus one option when the annuitant dies if the spouse is eligible for a survivor’s annuity. I received many email messages asking for the chapter and verse where this is stated so they will have it in writing.

Since then I found OPM’s Benefit Administration Letter 15-209 issued on October 20 that states as follows, “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.”

This should clear this up for all. When an annuitant dies, his/her spouse will retain their FEHB coverage as long as the survivor is eligible for a survivor annuity.

FEHB Plan Comparison Tool

There is an easy and convenient way to compare FEHB plans including how each plan treats your enrollment if you sign up for Medicare Parts A and B. I used the FEHB Plan Comparison Tool available on OPM’s web site and found it to be very helpful. I discovered a few unique features using the comparison tool that I didn’t realize existed. Now that my wife and I are both enrolled in Medicare I wanted to know how each plan handled Medicare enrollees and the cost savings afforded by each.  I was pleasantly surprised to find this very information at the bottom of the comparison report that I ran.

I compared four plans; Blue Cross Blue Shield (BCBS) Basic, GEHA Standard, MHBP Value Basic, and the APWU High Option plans. I currently have Blue Cross and Blue Shield Self & Family Basic.  The cost will be $348.29 for the Self Plus One Basic enrollment next year while the GEHA Standard premium is $241.25, a $107.04 monthly savings. The MHBP plan costs $303.65 and the APWU is $335.98. Cost alone is not the deciding factor. We have to evaluate each plan based on the desired health care coverage at the most affordable price.

Prior to turning 65, I was enrolled in the GEHA Standard plan and changed because of the deductibles, coinsurance, and copayments. GEHA waives these fees for Medicare A and B enrollees. This information is provided in the comparison and you can confirm what each plan covers in detail for Medicare enrollees in Section 9, Coordinating benefits with Medicare, that’s published in each plan booklet.

I called the GEHA plan help line and asked them specifically what my wife and I would not have to pay now that we are enrolled in Medicare. The agent confirmed that all coinsurance, copayments and deductibles were waived except for prescriptions. The other major GEHA plan feature is that unlike the BCBS Basic plan GEHA Standard covers both PPO and Non-PPO providers.  Of course there are other differences. The Standard GEHA plan limits the prescription mail order program to member only pharmacies similar to BCBS and others however there are  different payment limits as described in their brochures. Review each plan’s brochure thoroughly to determine what best meets your needs.

The comparison tool is an excellent first step to selecting your 2016 coverage. It includes 60 rows of data for the plans compared and it highlights the key areas. After I selected two plans of interest I reviewed each plan brochure to reveal other differences. For example with the GEHA plan you have to get pre approval for some admissions to the hospital and for certain diagnostic tests.  The doctors and hospitals typically take care of the pre approval but GEHA recommends you follow up with the hospital and/or testing facility to ensure the approval was obtained.

One of the major benefits of Medicare enrollment is that many FEHB plans waive all or some coinsurance, copayments, and deductibles since they become the secondary provider. It makes sense for Medicare enrollees to search for lower cost FEHB plans that do waive the most coinsurance, copayments, and deductibles to offset the cost of their Part B premiums. In my 4 plan comparison the only plan that waived ALL of these fees and out-of-pocket expenses was the GEHA plan. BCBS waived some.

Selecting the right plan for you and yours is a very important personal choice that deserves your undivided attention this open season. The comparison I provided is only an example to show how the tool works.  Use the comparison tool and plan brochures to make the best decision for you and your family this year.

2016 TRICARE Premium Increases

TRICARE premiums for retires and military personnel that have adult children are scheduled to increase in 2016. The Department of Defense announced new TRICARE premiums for Young Adult Prime and Standard option for children ages 23-26. Premiums will increase to $228 per month for the Standard option and $306 for the Young Adult Prime option.

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

Posted in BENEFITS / INSURANCE, FINANCE / TIP, RETIREMENT CONCERNS, SOCIAL SECURITY / MEDICARE, SURVIVOR INFORMATION | Comments (9)


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9 Responses to “FEHB Self Plus One Clarification, Plan Comparison Tool, & TRICARE Update”

  1. Floyd Rentz Says:
    November 12th, 2015 at 10:14 am

    It appears to me, the best deal for federal annuitants who have Medicare Part A and B (and pay a low rate for B) is to go with the Aetna Direct health plan. This is a new CDHP plan and seems a no-brainer for my situation. Have you reviewed this plan?

  2. Earl Grunden Says:
    November 12th, 2015 at 2:18 pm

    Please send me the information on health plans. I have been unable to get through on any other phone calls or websites. I need to get through before Open Season closes. This is importantly urgent for me. Thanks, Earl Grunden

  3. Carolyn Says:
    November 17th, 2015 at 9:30 am

    I need to know if I change to GEHA from Bkue cross plan. If I don’t like it can I go back to Blue cross the next year?

  4. james blanchard Says:
    November 17th, 2015 at 4:42 pm

    we have geha family high option and was paying $496.51 a month and it went to $556.68 a month for 2016. that is a $68.68 a month difference or 14% jump in premiums.

    why is it so much higher this year? we a squeaking by now, this new huge increase will do great harm to us.

    can we go to self plus one and be ok? we are just turning 70 and this is really hard to find out. also all the phone lines are busy all the time and hang up on us.

    so now what? please help, some one.
    thank you, georgie and jim blanchard

  5. Dennis Damp Says:
    November 18th, 2015 at 2:50 pm

    Georgie and Jim,

    Yes, the Self Plus One option for the standard GEHA plan is only $248 per month, the High Option GEHA is $496. My wife and I opted for the GEHA Self Plus One plan. The article I just published titled FEHB Open Season Plan Change Issues & Updates that will be sent out tomorrow talks about the GEHA Self Plus One Standard Option plan and the advantages. When you have Medicare Parts A & B it makes sense to look for a less expensive option since GEHA waives all deductibles, coinsurance and copayments when Medicare is your primary provider.

  6. Dennis Damp Says:
    November 18th, 2015 at 2:51 pm

    Yes, you have the option each open season to change to any plan.

  7. Dennis Damp Says:
    November 18th, 2015 at 3:10 pm

    If you are retired you can register and request brochures 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.

  8. Dennis Damp Says:
    November 18th, 2015 at 3:15 pm

    No I haven’t reviewed the Aetna Direct Health Plan. Each person has to evaluate which plan is best for their personal situation. I would make sure the plan actually waives all deductibles, coinsurance and copayments before you decide. Many plans don’t and some only waive some. Review Section 9 of the plan brochure to determine exactly how benefits are coordinated with Medicare and what the plan provides when you have both Medicare parts A and B.

  9. Mike Says:
    November 18th, 2015 at 8:56 pm

    FEHB Self Plus One Clarification (Almost)

    The OPM 15-209 letter solves part of my concern. In my view, the other unresolved part is that is I cannot find any definitive OPM “chapter & verse” that ascertains that the survivor annuitant of a deceased federal retiree has the option to change to a Self Only plan.