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How Does Geha Work With Medicare

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Your Final Decision On Medicare Part B And The Fehb Program

GEHA’s Understanding Medicare and the FEHBP Webcast

Throughout our advice we have highlighted specific advantages and disadvantages of enrolling in Medicare Part B in addition to your FEHB enrollment. On the minus side there is one large factorpaying two costly sets of premiums instead of one. For those who pay the higher part B income-tested premiums, this is a very considerable cost, at least $700 a year extra, and for some almost $6,000 extra to join Part B, depending on exact income level. On the plus side there are several factors, including avoiding network restrictions, better coverage for a few services, and having the option to join Medicare Advantage plans and paying only one premium without losing FEHB eligibility.

All of these options and the plans that save the most money within each option vary in details that you can only assess after studying the brochure of several plans. All of them can provide most annuitants substantial annual savings.

We show the extra cost of enrolling in both an FEHB plan and Medicare Part B and show which plans are likely to cost you the least or save you the most by enrolling in Part B. We present the plans in national and local groups, and within each list the plans in order of the lowest cost for self only enrollment in both FEHB and Part B. Some plans cost very little extra for Part B, taking into account both premium and enhanced benefits. These are sometimes the plans that offer the best premium reimbursements, and sometimes not.

How Do Fehbs And Medicare Work Together In Retirement

You can keep your FEHB plan after you retire as long as you meet a couple of requirements. The first is that youll need to go through the retirement process, not just quit your federal job. You wont be able to keep your FEHB plan if you leave your job under any circumstances other than retirement.

The second requirement is that youll need to have been enrolled in your current FEHB plan for at least 5 years or the entire period of time since you were first eligible to sign up.

So, if you dont start a federal job until later in your career, you can retire sooner than 5 years and still keep your FEHB plan. For example, if you start a federal job at age 59 and sign up for an FEHB plan, you can keep it even if you retire at age 62.

How Much Does Medicare Part B Coverage Cost

Medicare Part B generally pays 80% of approved costs of covered services, and you pay the other 20%. Some services, like flu shots, may cost you nothing.

Most people pay a monthly premium for Medicare Part B. The standard premium is $148.50 in 2021. You could pay more than that if your income is higher than a certain amount, and less if you qualify for state-based help if your income is lower than a certain amount.

A Part B deductible applies to some covered services. The annual Part B deductible is $203 in 2021.

After you pay your deductible, you generally pay a 20% coinsurance for most covered services.

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Two Parts Of Medicare

Part A . Most people do not have to pay for Part A. If you or your spouse worked for at least 10 years in Medicare-covered employment, you should be able to qualify for premium-free Part A insurance. Otherwise, if you are age 65 or older, you may be able to buy it.

Part B . Most people pay monthly for Part B. Generally, Part B premiums are withheld from your monthly Social Security check or your retirement check.

If you are eligible for Medicare, you may have choices in how you get your health care. Medicare + Choice is the term used to describe the various health plan choices available to Medicare beneficiaries. If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from a Medicare managed care plan. These are health care choices in some areas of the country. In most Medicare managed care plans, you can only go to doctors, specialists, or hospitals that are part of the plan. Medicare managed care plans provide all the benefits that Original Medicare covers. Some cover extras, like prescription drugs. To learn more about enrolling in a Medicare managed care plan, contact Medicare at 1-800-MEDICARE or at .

Get Help Comparing Medicare Plans Where You Live

Insurance

You may contact your local State Health Insurance Assistance Program for free assistance with your Original Medicare benefits.

If youre considering enrolling in a Medicare Advantage plan or a Medicare prescription drug plan, you can compare plans online for free or over the phone with the help of a licensed insurance agent. Learn about the costs, coverage and benefits of plans that may be available in your area.

Compare Medicare Advantage plans in your area

Or call to speak with a licensed insurance agent. We accept calls 24/7!

1 United States Office of Personnel Management . . Federal Benefits Open Season. Retrieved from https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/2019-open-season.pdf.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

Medicare has neither reviewed nor endorsed this information.

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How Do Fehbs Work If You Have Medicare

Youll be eligible for Medicare once you turn age 65. If you have health insurance from an FEHB plan, you can use it alongside Medicare. You can make a few combinations of Medicare and your FEHB plan depending on your circumstances.

Understanding the parts of Medicare and how they work together is key to deciding if using FEHB and Medicare together is right for you.

Do I Need Medicare If I Have An Fehb

In most cases, you can elect to not use your Medicare coverage and just keep using your FEHB plan. Medicare is an optional plan, meaning you dont have to have either Part A or Part B coverage.

However, there is an exception. If youre enrolled in TRICARE, an FEHB plan for military members, youll need to sign up for original Medicare to keep your coverage.

If you have any other FEHB plan, the choice is up to you. You can decide what works best for your budget and needs. Keep in mind, however, that Medicare Part A is normally premium free. Having Part A as extra coverage in the event of hospitalization is a good idea for most people since they have additional protection without paying higher costs.

While you dont have to enroll in Part B during your initial enrollment period, if you decide you want it later, youll pay a fee for signing up late.

This rule only applies if youre already retired when you become eligible for Part B. If youre still working, you can enroll in Part B once you retire. Youll have up to 8 months to enroll before you need to pay a late enrollment penalty. There is no late enrollment penalty for Part A.

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Are Geha Rates Affordable

GEHAs insurance rates are set based on whether you are a postal employee, work for another branch, or are a retiree.

The Standard option, for self-only, starts at bi-weekly premiums of $44.71 for postal employees and $53.86 for other employees. The High option starts at $89.15 bi-weekly for postal employees and $101.46 for other employees.

Rates are more than doubled for Self Plus One plans but do not increase as much for self and family plans.

It is not surprising that these rates are very low. Since the federal government backs these plans, employees get a greatly reduced rate. These rates cannot be compared to any marketplace or employer-sponsored plans anywhere else as they are specific to government employees.

Geha Medicare Benefits Guide

Part 2 – FEHB and Medicare Part B

High Option + Medicare

Self Only premiums.

Medical benefits for High with Medicare A & B primary. What you pay in- or out-of-network. geha.com/Find-Care Unlimited telehealth visits with MDLIVE geha.com/MDLIVE

Enroll code 311 . geha.com/Enroll

$234.31

Retirees monthly

Medicare A & B primary members pay less for brand-name prescription medications. Plan includes a $600 Medicare Part B premium reimbursement. geha.com/MRA X You pay $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network. X You pay $0 for inpatient and outpatient hospital services, surgeries and office visits. X You pay $0 for unlimited telehealth visits, including licensed behavioral health therapists and dermatologists, through MDLIVE. X You pay $0 for deductibles and copays outside the United States. X $2,500 hearing aid benefit. Benefits included with your High plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 1 geha.com/Vision Hearing aid discount 1 geha.com/Hearing Gym membership 1 geha.com/Fitness Electric toothbrush 1 geha.com/Toothbrush Teeth whitening 1 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 1 geha.com/LifeAlert Biometric screening geha.com/Screenings Out-of-pocket max 2 for High. What you pay in-network. 3 Self Only Out-of-pocket max $5,000 Self Plus One, Self and Family Out-of-pocket max $10,000

Self Plus One premiums.

Enroll code 313 . geha.com/Enroll

$545.85

$680.61

Retirees monthly

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What Happens If I Decline Fehb Coverage

If you decline FEHB coverage, you would give up the subsidy the government pays toward it, which ranges from a low of about $350 for self-only coverage to $1,000 or more if youre also covering family members. If your family members are covered under FEHB, their coverage would end if you terminate yours.

Will Fehb Be My Primary Coverage Or Medicare

If you have FEHB and do enroll in Medicare, then Medicare will be your primary coverage and your FEHB plan will pay after Medicare does. Having Medicare could reduce your out-of-pocket costs, because many FEHB plans waive cost sharing for enrollees who have Medicare. Even if this isnt the case, as long as your provider takes both your FEHB plan and Medicare, the most youd have to pay for care is the difference between what Medicare and your FEHB plan pay and Medicares limiting charge.

. Some states dont allow excess Medicare charges. If you live in one of these states or you see a doctor in any state that accepts Medicares rate as full payment youd only have to pay the difference between what Medicare and your FEHB plan pay and Medicares rate. Part Bs limits on what you can be charged dont apply to some services, and Part A doesnt have these limits.)

If you enroll in Part A but decline Part B, your FEHB coverage will pay after Medicare does for Part A services, but will be your primary insurer for other medical care. Medicare would no longer be your primary insurer if you return to work for the federal government, however, and in that case your FEHB plan would pay first, with Medicare paying at least some of your remaining costs.

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Mail Service Pharmacy 90

What you pay in-networkWhat you pay out of-network
Generic
40% ¤No benefit

Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store for greatercost savings.

¤If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.

#Reimbursement will be based on GEHAs costs had you used a participating pharmacy. You must submit original drug receipts.

Geha Basic And Medicare Part A And B

Insurance accepted at Premier Therapy Associates

Q: I have GEHA Basic and Medicare Part A and B. I take no prescriptions and go to the doctor very little, mostly to have tests done. I am considering dropping my Medicare B as I will have GEHA and Medicare A. I am interested in an unbiased answer.

A: Decisions like this are always personal. However, there are two things to consider before making a decision about dropping Medicare Part B. First, you need to review what benefits are included in Part B and decide whether you will need anything it covers that is not provided by your FEHB plan either now or in the future. Second, you need to be aware that if you drop your Part B coverage and want to re-enroll at a later date, youll have to wait for a general enrollment period, which is between Jan.1 and March 31 each year, wait for the coverage to be effective, which wont start until the following July, and pay a 10 percent penalty for each full year you could have been enrolled in Part B but werent.

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Do I Have To Enroll In Medicare Part B

What if you have other medical coverage, like an employers plan? Do you still have to sign up for Part B?

You can choose to delay Part B enrollment, as some people do when theyre covered under an employers or union-based health insurance plan. However, when that coverage ends, be aware that if you dont sign up for Medicare Part B within a certain period of time, you might face a Part B late enrollment penalty.

Heres one reason you might want to sign up for Medicare Part B. Suppose you decide youd like to buy a Medicare Supplement insurance plan. Or, you want to enroll in a Medicare Advantage plan. Both of these types of coverage require you to be enrolled in both Medicare Part A and Part B.

If you stay with Original Medicare and decide to sign up for a stand-alone Medicare Part D prescription drug plan, you need to be enrolled in Medicare Part A and/or Part B.

Please note that even if you decide to get your Original Medicare benefits through a Medicare Advantage plan, you still have to pay our monthly Medicare Part B premium. Of course, if the Medicare Advantage plan charges a premium, youll need to pay that as well. Some Medicare Advantage premiums are as low as $0.

Do you want to learn more about those Medicare coverage options we mentioned? Start comparing plans right away by typing your zip code where indicated on this page and clicking the button.

New To Medicare?

Everything You Need To Know About Medicare Part D

The Medicare Part D prescription drug program benefits millions of low-income elderly people. It fills a major hole in Medicare that lasted 50 years, but it will rarely benefit federal retirees who have good prescription drug coverage from their former employer. A typical plan costs $400-$500 in premium per year and provides little in the way of improved benefits for most.

Few federal retirees should join a Part D plan, but there are a few scenarios where it would make financial sense.

Federal retirees can decide to join Part D at any time as there is no penalty for joining Part D late. This is because federal retirees have creditable prescription drug coverage through their existing FEHB plan which negates late enrollment penalties.

One last thing to keep in mind is that Part D coverage is subject to premium adjustments for higher income retirees. If you fall into one of those categories, Part D plans make even less financial sense.

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Do Retired Federal Workers Need To Sign Up For Medicare Part B

Medicare Part B is optional medical insurance coverage, and it comes with a standard premium of $148.50 per month in 2021. If you are entitled to FEHB and Medicare benefits, Medicare Part B would serve as the primary payer and FEHB would act as the secondary insurance payer.

Your decision to enroll in Part B may depend on the benefits offered in your FEHB policy. Some of the things to consider include:

  • Part B may provide coverage for goods and services for which FEHB give zero or limited coverage.
  • Part B allows you to seek care any health care providers in the U.S. who accepts Medicare, while FEHB policies generally restrict you to a network of participating providers.
  • Because Medicare coordinates benefits with FEHB, you may be able to further reduce your out-of-pocket health care spending by pairing Part B with FEHB and taking advantage of the double coverage.
  • If you wish to join a Medicare Advantage plan that offers dental or vision coverage , you must be enrolled in Part B.

Federal Employee Retirement Health Benefits And Medicare

Medicare Part B and FEHB

Home / FAQs / General Medicare / Federal Employee Retirement Health Benefits and Medicare

Before you retire, its important to explore all your health care coverage options. For those in the Federal Employee Health Benefits Program who are also Medicare-eligible, this can be a bit tricky. Thats why were here to help you understand how to coordinate your coverage when youre eligible for FEHB and Medicare!

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Outside The United States

If you live outside the United States, your GEHA coverage travels with you. For your convenience, providers outside the United States are paid at the GEHA preferred provider rate for medically necessary covered services. If you have Medicare Part A and Part B primary, GEHA waives the calendar-year deductible and coinsurance with our Standard, Elevate Plus and High medical plans when you receive medically necessary covered services, even when those services are received overseas.

Contact GEHAGEHA members outside the United States can call us using a dedicated phone number. In addition, GEHA will accept collect calls from our members overseas.

When calling from outside the United States:

  • Call the AT& T USADirect® access number for the country from which you’re calling.
  • Then, enter our GEHA toll-free number: 320-9469. Do not dial a “1” before the 877.
  • Because time zone differences may make it difficult to reach us, you can access GEHA through this website. We have an email address for the use of our members outside the United States. Send a secure email to GEHA via secured email form by clicking .

    Provider NetworkProviders outside the United States are paid at the GEHA rate for medically necessary covered services. See your Plan Brochure for more information.

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