Your Open Season Q&A

There have been a lot of questions coming into my email box in preparation for the upcoming FEHB/PSHB Open Season that begins on Nov. 11 for active and retired federal and postal employees. Here are some of the ones that might help you this open season: 

Question: I am currently retired, and both my wife and I are covered under BCBS Standard option (Plan 106, Self Plus One) with original Medicare as our primary. With premiums expected to increase by $102.49/month ($832.31/month for 2025) and the open season upon us, I am considering switching to BCBS basic option. I understand Medicare would pay the first 80% but would the Basic option pick up the remaining 20% as does the standard option. I also understand that once we elected the basic option, we would be eligible for some sort of Medicare Part B premium reimbursement. 

Answer:  That will save you some money in 2025 as the BC/BS Basic Plan (113 Self Plus One) enrollment will have a premium of $593.97/month. Medicare will be the primary payer when you see BC/BS Preferred Providers with this plan which will leave you with a $0 copay. Medicare Part B pays 80% of the reasonable charge for covered physician services, and many federal plans, including BC/BS plans, pay the remaining 20%. Some FEHB plans provide a partial rebate of the Medicare Part B premium and BC/BS Basic is one of those plans with this benefit. BC/BS Basic members can get up to $800 back (per spouse enrolled in Medicare Part B) for paying Part B premiums. One important difference between BC/BS Basic and other fee-for-service plans is that you must use Service Benefit Plan Preferred providers to have your cost shares eliminated. Under Standard Option, you can see any provider. See the FEP Blue and Medicare brochure to learn more.  

Question: I am wondering if it is beneficial to retire on December 31st while I am covered by FEHB vs waiting until 2025 and then retire once I am covered under PSHB? I have 40 yrs service & need to make that decision soon. 

Answer: You may retire on 12/31/2024 and you will receive confirmation that your current insurance is transferred to OPM. The Office of Personnel Management will have a procedure for retiring postal employees who are transitioning to the PSHB. There should not be any problem as OPM, and the Postal Service are aware that many employees will be retiring at the end of the year.   

Here is the procedure that is already in place when an employee retires before an open season change takes effect: 

A “cover sheet” is used by the agency when a retiring employee is making an open season change and will retire before the change takes effect. Every year, there are employees who make an FEHB Open Season enrollment change, then retire before the effective date of the change (first day of the first full pay period in January). The agency includes the enrollment transaction with the retirement package sent to OPM and OPM processes the enrollment change.  

If the agency knows an employee will retire before the open season change takes effect, they are required to do the following:  

1. Have the employee complete SF 2809, Health Benefits Election form.

2. Attach the SF 2809 to other health benefits documents and the Individual Retirement Record (SF 2806 under CSRS and SF 3100 under FERS) when they are submitted to the retirement system. Keep a copy of this SF 2809 in the employee's eOPF as verification.  

3. After assuring that the five-year rule has been met, prepare a memo to the retirement system stating that the open season SF 2809 was submitted on a timely basis and should be accepted for processing. The retirement system will transfer in the old enrollment on another SF 2810 and then process the open season SF 2809. 

Use this reference from OPM regarding the upcoming Open Season for postal employees and annuitants.  

Automatic Enrollment in Postal Service Health Benefits (PSHB) 

The PSHB Program is a new, separate program within the Federal Employees Health Benefits (FEHB) Program, which will provide health insurance to eligible Postal Service employees, Postal Service annuitants, and their eligible family members starting Jan. 1, 2025. Learn more about PSHB. 

OPM is working to make the transition to PSHB as simple as possible by automatically enrolling Postal Service members into a PSHB plan based on their current FEHB enrollment. Postal Service enrollees, annuitants, and their family members who are currently enrolled in any FEHB plan not available under PSHB will be automatically enrolled in the PSHB nationwide plan option with the lowest self-only premium that is not a high deductible health plan and does not charge a membership fee. For the 2025 PSHB benefit year, this plan is the Blue Cross Blue Shield Service Benefit Plan FEP Blue Focus (35A/35B/35C). 

Postal Service enrollees always have the right to choose their PSHB plan during the Federal Benefits Open Season. This year, Open Season will run from Nov. 11, 2024, through Dec. 9, 2024. 

Question: Are there any new fee-for-service health plans available for 2025? 

Answer: Compass Rose Health Benefit plan is a plan that has been restricted to employees who work in intelligence agencies such as CIA, NSA and DIA, however beginning in 2025, this plan will be open to all eligible FEHB enrollees. This insurance has been providing coverage since 1948. It should be noted that Postal Employees and Annuitants are no longer eligible for this plan (unless currently under Temporary Continuation of Coverage). To learn more about this plan’s Standard, High, and Medicare Advantage options, check out the 2025 plan brochure and the Compass Rose Health Plan website.  

To learn more about other FEHB changes for this open season, check here: 2024 Federal Benefits Open Season: Significant Plan Changes for the Federal Employees Health Benefits (FEHB) Program 

For Postal employees and annuitants, check here: 2024 Federal Benefits Open Season: Postal Service Health Benefits (PSHB) Program Significant Plan Updates

Question: I am trying to determine with FEHB plan will provide wrap around coverage when Medicare Part B is primary (for retirees), and how I need to choose my plan for 2025. I am retiring on January 31, 2025. I am over 65 and have Medicare part A, same for my husband. I tried to get a checkbook, but DOD (my agency) did not participate and so I was concerned that I could not get a good comparison. Would it behoove me to get consumer checkbook even though my agency does not participate? I was so upset by this lack of participation that I reached out to our HR chief and told her to get the show on the road, to join before next year. 

I will need a healthcare plan as an active employee for myself and my husband through January 31st, while FEHB remains primary.  

But I need to choose a plan that will work with Medicare Part B come February 1st, and I am not sure how to protect us through the end of January and still get the best plan that will work for us from February till the end of next year? Retirement is not a qualifying event, so I get one shot at this. 

 Answer: There are quite a few plans that will work for you. First, however, here are a couple of things to know: 

The plans I am recommending below will work well for you as an active employee for January 2025 and then for you and your husband when Medicare is the primary payer after you retire on Jan. 31. This is not an all-inclusive list of plans. Here is where you can locate all the available plans in your area: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/  

You are already over 65 and you enrolled in Medicare Part A as an employee. You can enroll in Medicare Part B within 8 months of your retirement during a Special Enrollment Period (SEP) from Feb. 1- Sept. 30. Here is a fact sheet on your SEP. Note that there are two forms indicated on this fact sheet; CMS L564 that you will need to have your agency complete to show that you have had "employer-sponsored health insurance while you were employed through Jan. 31 and CMS 40-B which is the form to enroll in Medicare Part B during your SEP. If your husband is over 65 and only enrolled in Part A since he was covered under your "current employment" health insurance, you will need to get an L-564 completed for him as well so that neither one of you will incur a late enrollment penalty for Medicare Part B. Note that on this fact sheet, there are alternative ways to show that you had employer coverage if you aren't able to get someone at your agency to complete the L-564 for you and your husband. 

To-Do List: 

•  Order Checkbook Guide. This guide is updated for the 2024 open season, is well worth the price even if your agency does not provide this resource for you, and will help you compare the plans side by side (up to four at a time). Members of the National Active and Retired Federal Employees Association receive a discounted rate.   

• Choose your plan between Nov. 11 and Dec. 9 using your agency's online system: 

• When choosing the “best” plan for your family, it is important to consider your healthcare needs when choosing coverage. 

All of the plans on the list below will waive your "cost-sharing" (deductible, copays, coinsurance) when Medicare is the primary payer, leaving you with $0 out-of-pocket costs (other than prescription copays, dental, vision, and some cases, when you use out-of-network providers-in particular-BC/BS Basic Option requires you to see BC/BS Preferred Providers; the other plans listed cover both in and out of network providers) 

Consider your needs, such as diabetic supplies, hearing aids, chiropractic, physical therapy, or acupuncture. For example, check plan limits by looking at the plan brochure. You can search by clicking the "Control" and "f" keys at the same time and entering a keyword such as "acupuncture" or "hearing aids." 

Please look at your prescription needs.  Most plans offer and will enroll you in a Medicare Part D plan that will cover the same drugs covered by the underlying FEHB plan (if you join the Medicare Advantage option of the plan, you will only use the Part D coverage included in the MA option).  Look at the copays/coinsurance if you need more expensive medications, such as a name-brand drug or something that may not be on the plan formulary.   

You will have a Special Enrollment Period to enroll in Medicare that will last eight months following your Jan. 31, 2025, retirement. Enroll in Medicare Part B (you and your husband) before Sept. 30, 2025 (if you are both in good health and want to delay enrollment until later, that will save you the premium for Part B while in the SEP). 

If you want to switch to a plan that works well with Medicare A & B but not as well if you aren't enrolled in both A & B, you have a "once in a lifetime" Qualifying Life Event" that you can use any time after you reach age 65; it is QLE 2L and you can use OPM Form 2809 to make this change. 

Consider these additional plans once you are both enrolled in A & B of Medicare: 

• Aetna Direct (Plan Code N63, $365.21/month with a $900/spouse rebate for Medicare Part B premium) or 

• Aetna Advantage (This is a plan with a Medicare Advantage option, Plan Code Z26, $253.74/month with $125 reduction in monthly Part B premium)  

• https://www.aetnafeds.com/retiree-plans.php   

Here are some self-+1 plans to consider for 2025 that work well with and without Part B: 

•  BC/BS Basic Option, Plan Code 113, $593.97/month (Part B rebate of $800 each or $1,600 per couple)  

• GEHA Standard or High Option, Plan Code 313, $666.08/month or Plan Code 316, $374.18/month (Part B rebate of $1,000 each or $2,000 per couple using the high option of this plan; both Standard and High Option offer a Medicare Advantage option once you both have Medicare A & B) 

• Standard Option: https://www.geha.com/plans/medical/2025/fehb/standard-option  

• High Option: https://www.geha.com/plans/medical/2025/fehb/high-option  

• Medicare Advantage Option: https://www.geha.com/plans/medical/medicare-advantage  

• Compass Rose High Option (now open to all FEHB eligible employees and annuitants), Plan Code 423, $605.91/month (Once you both have Medicare A & B, you can join the Medicare Advantage option of this plan, and your Part B premium will be reduced by $125/month). 

• Here's the description without Medicare Advantage that would apply with or without Medicare: https://www.compassrosebenefits.com/members/high-option-health-plan  

• NALC High Option, Plan Code 323, $690.54, use Self & Family for this plan, Plan Code 322, $615.20/month (this plan offers a Medicare Advantage plan when enrolled in Medicare A & B).

• MHBP Standard Option, Plan Code 456, $418.10/month (Once you both have Medicare A & B, you can join this plan's Medicare Advantage option and receive a reduction in your Part B premium of $75/month each).

There are other plans that may work well for your situation and for where you live.  It is best to do a plan comparison with three or four plans and then narrow your options to the top plan that best meets your needs.