Is It Time for FEHB Enrollees to Think about Part D Too?

[zl55lz]

Up until now there has been general consensus that one doesn't need Medicare Part D prescription coverage since FEHB plans cover Rx so well.

Maybe not anymore?

The new law passed this year by Congress has some changes to Part D which could benefit FEHB enrollees as well.

For instance, starting in 2025, the out of pocket (oop) limit for Part D plans for Rx will be $2000. That is significant. While FEHB will probably still cover most Rx as good or better, this new oop limit could help in instances where someone on FEHB has Specialty Rx which normally wouldn't be fully covered until the much higher FEHB catastrophic yearly limit is reached--usually in the $5000 to $8500 range (although I believe NALC High has a separate $4000 Rx limit). For instance, I think the Specialty Rx cost for BCBS Focus, a very low-priced plan, is $350 per 30 day fill, which would be $4200 oop per year--but not if using a Part D plan?

In addition, for those who require insulin for diabetes, Part D plans are limited--starting this coming year in 2023--to a $35 per month copay WITHOUT having to pay a deductible first. I have not been able to verify which brand insulins, but apparently each plan has to offer some.

These are big changes which could help FEHB enrollees too? Although Part D would then become the primary Rx insurance, I think the FEHB would then act as secondary sort of like with Part B+FEHB medical claims now?

Hopefully the FEHB plans will voluntarily offer this lower oop for their own plans but I would be surprised if they do.

Any comments?

 

[donheff]

I see that FEHB is "creditable" coverage for enrolling in Part D without penalty. What is not clear to me is whether you can enroll without being in Part B or how it would interact with FEHB Rx coverage.

 

[zl55lz]

I see that FEHB is "creditable" coverage for enrolling in Part D without penalty. What is not clear to me is whether you can enroll without being in Part B or how it would interact with FEHB Rx coverage.

From what I have read, to enroll in Part D, one must be "eligible" for Medicare in the usual ways (65 or disabled requirements, etc.). Then, one can enroll in Part D if eligible for but not enrolled in Part A, or if enrolled in Part A only, or if enrolled in Part B only.

That is what I read.

As far as coordination of benefits between Part D and FEHB, supposedly the Part D becomes primary for Rx coverage, and FEHB secondary. I guess the pharmacy would then run it through like that? Hopefully one would not have to submit the secondary coverage oneself.

I know some plans do mention the coordination of Rx in their brochures but none I have seen state what amount is covered. I think a call to the insurance company would be needed for details. I don't know if FEHB would then cover the balance which Part D did not, or if this would just work for cases like I mentioned such as insulins or specialty Rx.

I have heard GEHA specifically mentioned as working in a Part D/FEHB combo.

Certainly worth looking into in my opinion. Hopefully some in the group can share if they know anything about this.

 

[donheff]

From what I have read, to enroll in Part D, one must be "eligible" for Medicare in the usual ways (65 or disabled requirements, etc.). Then, one can enroll in Part D if eligible for but not enrolled in Part A, or if enrolled in Part A only, or if enrolled in Part B only.

That is what I read.

As far as coordination of benefits between Part D and FEHB, supposedly the Part D becomes primary for Rx coverage, and FEHB secondary. I guess the pharmacy would then run it through like that? Hopefully one would not have to submit the secondary coverage oneself.

I know some plans do mention the coordination of Rx in their brochures but none I have seen state what amount is covered. I think a call to the insurance company would be needed for details. I don't know if FEHB would then cover the balance which Part D did not, or if this would just work for cases like I mentioned such as insulins or specialty Rx.

I have heard GEHA specifically mentioned as working in a Part D/FEHB combo.

Certainly worth looking into in my opinion. Hopefully some in the group can share if they know anything about this.

Thanks. I don’t need it now but could envision a future where I would be interested. I have GEHA and Part A, not Part B. The IRMAA increases in two years would be onerous.

 

[zl55lz]

Thanks. I don’t need it now but could envision a future where I would be interested. I have GEHA and Part A, not Part B. The IRMAA increases in two years would be onerous.

This is interesting. I checked further, and the other FEHB plans I looked at stated they would "consider" Rx for payment after Part D pays, but NALC High (a great overall plan from what I have read) states "When we are the secondary payor we will pay the balance after Medicare Part D pays, up to our regular benefit."

Whatever that actually means.

However, having Aetna Direct now, we have never paid a cent out of pocket for anything including Rx copays/coinsurance because of the automatic deduction from the fund ($1800 self+one). Difficult to beat that. Although, I could still see a benefit to Part D when the $2000 oop max starts in 2025 if one was on FEHB with expensive specialty Rx situations.

 

[zl55lz]

Just a heads up about a post over at Bogleheads about possible new FEHB MA and stand-alone Part D offerings. I read the actual gov't OPM letters to insurance companies about this proposal. Will be interesting to see how it develops and could be very beneficial. Major change. Wonder if it really would make 100% Rx coverage possible via coordination of benefits like Part B with FEHB now does?

I think it is well worth the read.

Anyone have any comments about such a major FEHB change?

 

[teej1985]

Just a heads up about a post over at Bogleheads about possible new FEHB MA and stand-alone Part D offerings. I read the actual gov't OPM letters to insurance companies about this proposal. Will be interesting to see how it develops and could be very beneficial. Major change. Wonder if it really would make 100% Rx coverage possible via coordination of benefits like Part B with FEHB now does?

I think it is well worth the read.

Anyone have any comments about such a major FEHB change?

Why not link it so that people don't have to hunt for it?

 

[zl55lz]

https://www.govexec.com/pay-benefit...l-feel-impact-medicare-part-d-changes/383881/


https://www.govexec.com/pay-benefits/2023/03/keep-eye-these-potential-benefits-changes/383799/

https://www.bogleheads.org/forum/viewtopic.php?t=400239



These are the links regarding my previous post about the proposed FEHB Part D and MA offerings, etc. Please note that there are links within some of those articles which will take you to further sources. Thanks to teej1985 for suggesting this.

 

[zl55lz]

Best summary article of upcoming new FEHB Part D changes I have seen to date:

https://fedretire.net/big-changes-i...rescription-drug-benefits-in-2024-and-beyond/

 

[donheff]

Best summary article of upcoming new FEHB Part D changes I have seen to date:

https://fedretire.net/big-changes-i...rescription-drug-benefits-in-2024-and-beyond/

Pretty good introduction to 2024 choices. My choice to forgo Part B still appears to be best since out IRMAA charges would be high now and higher still in two years.

 

[zl55lz]

Pretty good introduction to 2024 choices. My choice to forgo Part B still appears to be best since out IRMAA charges would be high now and higher still in two years.

Although, I do find it hard to believe, as the article seems to state, that FEHB will offer stand alone Part D plans for zero extra premium. Not sure how that will work?

 

[zl55lz]

Best summary article of upcoming new FEHB Part D changes I have seen to date:

https://fedretire.net/big-changes-i...rescription-drug-benefits-in-2024-and-beyond/

Upon looking at this article again, it is worth noting that (under the section on "FEHB PDP Plans" for Part D) that it is mentioned that FEHB plans might have the option to AUTO-ENROLL people who are currently on whichever FEHB plan they are in and who are on Medicare into one of the Part D plans. Not sure if all this will roll out in the upcoming 2024 Open Season but it is something to be aware of for future open seasons. I know I want the option to be in whichever Rx coverage I choose, whether the regular FEHB plan or a Part D option, and not via auto enrollment. The article appears to state, in my opinion, that whichever plan one is in might have the ability to put one in a Part D plan and the enrollee would then have to opt-out if they don't want it (or want to change to a different one, or remain in the regular Rx plan which came with the plan to begin with?). Anyway, something to be aware of.