FEHB Part D Rx Rollout Info

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zl55lz

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For those on FEHB (Federal Employees Health Benefits), there is an interesting thread over at Bogleheads.org about BCBS's new Part D Rx choice.

Titled "Big News For Those On FEHB BCBS And Other Plans" dated 10/01/23.

This is a big deal and I suspect other FEHB plans might offer similar soon.

I would be interested in any comments on this.
 
teej1985 said:
Not sure why there's a reference without a link - or what comments would occur here that won't occur there.

https://www.bogleheads.org/forum/viewtopic.php?t=413807
Click to expand...

Thanks for posting the link. I was assuming it was no trouble to pull up the site. Also, I did not think everyone who is on this site is also on that site, so thought it might be of interest to some people here too who might have a viewpoint on it.
 
Some discussion is always nice in a discussion forum like this one. So here's what I came up with: From the helpful link given by teej1985, I was able to read the thread and noticed this was mentioned:

[...]BCBS has already put on their FEHB site something called Medicare Prescription Drug Program (MPDP) for those on any of their three plans beginning 2024.

Note: Those on these BCBS plans in FEHB and who are on Medicare will apparently be AUTOMATICALLY enrolled in this. If one wants to opt out back to the regular plan Rx, one must notify BCBS per instructions.
Click to expand...

So, those of us on Medicare with FEHB BCBS plans apparently don't need to do anything about this if we want to enroll. Possibly other FEHB plans might decide to make enrollment automatic as well; time will tell.
 
W2R said:
Some discussion is always nice in a discussion forum like this one. So here's what I came up with: From the helpful link given by teej1985, I was able to read the thread and noticed this was mentioned:



So, those of us on Medicare with FEHB BCBS plans apparently don't need to do anything about this if we want to enroll. Possibly other FEHB plans might decide to make enrollment automatic as well; time will tell.
Click to expand...

I was hoping for better from this Part D option, but at least one nice thing is the out of pocket yearly limit. I wonder if they will be required to drop it to $2000 when the new regulation starts in 2025?

Another helpful thing could be paring the D option with FEHB plans which seem to not be traditionally strong in the Rx area.

You are correct--time will tell.
 
zl55lz said:
I was hoping for better from this Part D option, but at least one nice thing is the out of pocket yearly limit.
Click to expand...

Yes, that's nice! $3,250/year is not cheap but it could be so much worse. $2,000/year would be even better.

Personally I was just started on twice daily insulin injections a month or two ago. I am hoping that my share of the cost of insulin doesn't go up drastically.

People say here that the elderly spend less as they grow older, but who knows. :rolleyes: I am age 75 and hope that my spending does go down, and that my medications remain the same cost or cheaper.

Sometimes buying one's prescriptions at the pharmacy feels like a trip to the casino. I know it's not but gee, some prescription drugs have become so expensive.
:rant::peace:
 
Update: To date I have only seen the Part D info for two of the plans---BCBS and NALC. I am not sure yet what the value would be to enrollees versus the regular plan Rx benefits. BCBS Part D versus regular BCBC Rx seems to be a very little cheaper?

I thought when FEHB announced they would open plans up to offer Part D, that it would be a number of standalone Part D plans which one could pick to go with any particular health plan. So far that does not seem to be the case. Rather, each participating plan is apparently choosing whether to offer their own version of a Part D plan. So far, I have read that the following plans are participating in 2024 (to offer a Part D option with the "regular" FEHB plan):

BCBS Standard, Basic, and Focus.
NALC High
MHBP Standard
APWU High
SAMBA High and Standard
Aetna Direct

Also, GEHA High and Standard are going to have a new Medicare Advantage (MA) option through UnitedHC: the other nationwide (open to all) MA plans for 2024 supposedly will be through NALC High, MHBP Std, APWU High, SAMBA High and Std, and Aetna Medicare Advantage. These of course use a Part D plan included. MA plans seem to be the direction FEHB is going in for annuitants.

One could also use a publicly offered standalone Part D plan to go along with a FEHB regular plan. I personally would consider this if I were choosing the regular GEHA Std plan because it would fit some of my spouse's Rx better.
 
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FEHB GEHA is trying to hand-off its Medicare primary insurance plan to what looks like a non-FEHB United Healthcare Advantage Plan. I need to confirm but, where BCBS appears to be an opt-out, I am under the impression GEHA is a opt-in. But it sounds like you switch from Medicare providers to United Healthcare providers. I would say NO, absolutely NO, to that. Most providers near me accept Medicare assignment. My doctors are not in-network for United Health's plan. I absolutely reject any switch to a non-Medicare primary Advantage plan that I did not choose. No sneakers are worth that. It feels like they are picking a plan for me. So, I had no choice among the various Advantage plans. (Our network has been determined by Aetna's network. In order to do this, they are changing the network around my area for everyone to United Healthcare.)

https://www.geha.com/plans/medical/medicare-advantage
You must remain a GEHA High/Standard FEHB Health Plan member in the FEHB program if you elect to enroll in the GEHA Medicare Advantage Plan. Plans are offered by GEHA and insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.
Click to expand...
 
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Tadpole said:
FEHB GEHA is trying to hand-off its Medicare primary insurance plan to what looks like a non-FEHB United Healthcare Advantage Plan. I need to confirm but, where BCBS appears to be an opt-out, I am under the impression GEHA is a opt-in. But it sounds like you switch from Medicare providers to United Healthcare providers. I would say NO, absolutely NO, to that. Most providers near me accept Medicare assignment. My doctors are not in-network for United Health's plan. I absolutely reject any switch to a non-Medicare primary Advantage plan that I did not choose. No sneakers are worth that. It feels like they are picking a plan for me. So, I had no choice among the various Advantage plans. (Our network has been determined by Aetna's network. In order to do this, they are changing the network around my area for everyone to United Healthcare.)

https://www.geha.com/plans/medical/medicare-advantage
Click to expand...

Yes, many of the Medicare Advantage Plan options in FEHB use a different company--at least in name--than the regular plan. For instance, the regular FEHB plan might be Cigna, while the MA option within that plan is through UHC. Not sure why since so far one has to remain in the regular plan as well to get the MA option. And it is true, once one opts into the MA option, one is no longer in "original Medicare" as primary with the FEHB plan as secondary, but rather are solely in the MA plan which is not "original" Medicare, even though one is still paying for Parts A and B!!
 
Tadpole said:
FEHB GEHA is trying to hand-off its Medicare primary insurance plan to what looks like a non-FEHB United Healthcare Advantage Plan. I need to confirm but, where BCBS appears to be an opt-out, I am under the impression GEHA is a opt-in. But it sounds like you switch from Medicare providers to United Healthcare providers. I would say NO, absolutely NO, to that. Most providers near me accept Medicare assignment. My doctors are not in-network for United Health's plan. I absolutely reject any switch to a non-Medicare primary Advantage plan that I did not choose. No sneakers are worth that. It feels like they are picking a plan for me. So, I had no choice among the various Advantage plans. (Our network has been determined by Aetna's network. In order to do this, they are changing the network around my area for everyone to United Healthcare.)

https://www.geha.com/plans/medical/medicare-advantage
Click to expand...



I'm pretty sure all of the FEHB Medicare Advantage options are opt in. I don't know that FEPBlue even has a Medicare Advantage option.
 
If I am reading the NALC 2024 brochure correctly in Section 9, it looks like for those who do use the new Part D with the regular NALC High plan, they will get a reimbursement amount of $600/yr for self only or $1200/yr for Self+One (both enrolled). I did not see anything like this with BCBS for the Part D enrollees (MPDP). This is a nice perk.

There will be more of these Medicare Prescription Drug Plan offerings for 2024 so check and verify each plan for specifics--they apparently can be designed differently for each plan.

https://www.nalchbp.org/pdf/2024-Brochure.pdf
 
As someone in FEHB who will turn 65 next year and is on a specialty medication, this is devastating. My current CVS specialty pharmacy is working well and I have not had issues with approvals.

Sounds like my wife is right to be scared of Medicare.
 
Out of Steam said:
As someone in FEHB who will turn 65 next year and is on a specialty medication, this is devastating. My current CVS specialty pharmacy is working well and I have not had issues with approvals.

Sounds like my wife is right to be scared of Medicare.
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I have found FEHB+Medicare A&B to be the best insurance we have ever had, much better than when we were on FEHB only. If original Medicare is matched with a good FEHB plan, there can be zero out of pocket, and if matched with a certain plan with a HRA fund, possibly no out of pocket for Rx either.

If both spouses will not be on Medicare at the same time, it is wise to pick the best FEHB plan which matches both of those involved needs. There are very solid plans which can do this.

There are more FEHB Medicare Advantage plans being rolled out which might fit some needs.

The things I always look at with FEHB plans are premium, out of pocket max, prescription coverage, Skilled Nursing Facility coverage, premium increase history, and network coverage.

Regarding the specialty Rx, starting in 2025 there is supposed to be a $2000 out of pocket limit for Part D so this might help, even if possibly paring a public Part D plan with original Medicare and the FEHB plan of choice.
 
(Chuckle) I have decided that it borders on cruel to create more and more complexity in the Healthcare Insurance choices for older people like me who may lose the sharpness it takes to read between the lines.

I do have another choice I didn't consider at the time because Medicare+GEHA High was working pretty well. I could suspend FEHB and pick up CHAMPVA instead. I would need to study this option. The fact I could not find any discussion of others considering this change tells me that, if others have looked into it, they decided to stick with FEHB. Financially, the best of all worlds might be a CHAMPVA add-on to Medicare+GEHA but I don't think you can have all three or, at least, I don't see how network requirements would coordinate especially for prescriptions.

In the meanwhile, I am calling GEHA and having them directly confirm that, as in the past, doing nothing leaves me with the same plan I currently have. Maybe I won't be around when they take the current plan option away.
 
Tadpole said:
I could suspend FEHB and pick up CHAMPVA instead.
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You have a nice option there. Even if you keep FEHB, consider getting on champva. It's zero-premium insurance, and it has a drug plan.
 
zl55lz said:
Update: To date I have only seen the Part D info for two of the plans---BCBS and NALC. I am not sure yet what the value would be to enrollees versus the regular plan Rx benefits. BCBS Part D versus regular BCBC Rx seems to be a very little cheaper?

I thought when FEHB announced they would open plans up to offer Part D, that it would be a number of standalone Part D plans which one could pick to go with any particular health plan. So far that does not seem to be the case. Rather, each participating plan is apparently choosing whether to offer their own version of a Part D plan. So far, I have read that the following plans are participating in 2024 (to offer a Part D option with the "regular" FEHB plan):

BCBS Standard, Basic, and Focus.
NALC High
MHBP Standard
APWU High
SAMBA High and Standard
Aetna Direct

Also, GEHA High and Standard are going to have a new Medicare Advantage (MA) option through UnitedHC: the other nationwide (open to all) MA plans for 2024 supposedly will be through NALC High, MHBP Std, APWU High, SAMBA High and Std, and Aetna Medicare Advantage. These of course use a Part D plan included. MA plans seem to be the direction FEHB is going in for annuitants.

One could also use a publicly offered standalone Part D plan to go along with a FEHB regular plan. I personally would consider this if I were choosing the regular GEHA Std plan because it would fit some of my spouse's Rx better.
Click to expand...

Update: Also, MHBP Value and Consumer, some Aetna Open Access plans, as well as other plans in FEHB will offer Part D plans with their regular plans in addition to the aforementioned.
 
APWU High and Consumer Part D info also now available on their site in 2024 brochure (see previous post for link).

Other plans which are participating can be checked at the same OPM site as they are rolled out and site(s) updated.
 
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teej1985 said:
IRMAA wouldn't be considered an additional premium, nobody knows how it's going to work - it's all new.
Click to expand...

Thanks for pointing this out. I did some more reading and it appears the plans are paying for the Part D option itself, while the enrollee is responsible for their level of IRMAA.

I hope people aren't caught by surprise by being automatically enrolled in these plans, or worse, an extra cost due to IRMAA.

The good news is that enrollees can opt back into the normal FEHB prescription option.
 
Now that these new FEHB Part D plans have posted their details, I am surprised at the wide variety of differences in the various Part D options. In looking again at various regular FEHB Rx plans, I am also surprised that so many of them (the "regular" Rx) appear to not even be as good as the Part D plans offered to the public, which in many cases at least offer Tier 1 and Tier 2 meds for zero cost.

Having said that, it looks to me like the new Part D option for Aetna Direct appears to be a great option. The only thing I really don't like is that it will not automatically deduct the Rx coinsurance from the HRA fund like the regular plan did. That is such a nice feature. The good news is that the fund is still there and can be requested as a Medicare Reimbursement like some other plans.
 
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