Five years! No, you haven’t been in an FEHB plan for the past five years. You got your health insurance through your significant others’ private employer. Maybe it was less costly. But whatever the reason for piggybacking on a spouses private plan, things change when it comes time to retire. And now that they are retiring — unlike Uncle Sam — no more company-backed health plan. Your fallback has always been to switch one of the FEHB plans when you retire from government. Good plan, except it won’t work. You’ve violated the five-year rule.

That isn’t a problem for federal and postal workers who had family plans while working. Especially the last five years of employment. But if they didn’t have FEHB coverage (any plan or option would do) for their last five years of federal employment, they won’t be able to get FEHB coverage when they retire. There are some rare exceptions, but in most cases the five-year rule prevails. Meaning you may have to work another five years before you can retire under the FEHB program.

Here’s how insurance experts Walton Francis explains it in this years Checkbook’s Guide to Federal Health Plans:

 …do not assume that you need not enroll in the FEHB program just because you have other coverage.

If your spouse has a low-cost health plan through a private employer, or you have a health plan from prior employment, check to be sure that it covers you and your children, and has a benefit package as good as the Federal plans.

Even if your spouse’s plan is every bit as good as any of the Federal plans, consider the cost of this coverage compared to some of the lower-premium Federal plans. Remember that you must be covered under the FEHB program continuously for the five years preceding retirement to continue enrollment after retirement (there are some very rare exceptions, such as certain agency downsizing situations). You don’t have to be in the same plan in each year, but you must be covered continuously by some FEHB plan or, in the special case of former military, TRICARE.

Most importantly, if you should die while you are not enrolled in a FEHB family plan, your spouse will lose eligibility for the program. Since most employers do not continue coverage past retirement, or cannot be counted on to do so, your only guarantee that your spouse can keep this entitlement is to be continuously enrolled. There is an excellent strategy for doing so at minimum cost. All of the plans showing a very low or negative number in the “No Costs” column are Consumer-Driven or High Deductible plans that give you a savings account as large as or larger than the premium. With double coverage you will probably not ever reach the high deductible and will realize this saving in most circumstances. In other words, these plans really are almost “free” if they supplement other coverage from your spouse.

Nearly Useless Factoid

By Alazar Moges

The coldest temperature ever recorded in the United States was on Jan. 23, 1971 when it reached -80 degrees fahrenheit in Prospect Creek, Alaska.

Source: State Climate Extremes Committee (SCEC)

What if you worked for an outfit that paid most of the premium for dozens of health plan options available to you, and allowed you to shop on the clock? And even paid for an on-line service that would give you several best-guys-for-you options?

If you work for Uncle Sam there’s a 50/50 chance you do. That is, your agency has pre-paid so you can shop from home, office or home/office using the popular Checkbook’s Guide to Federal Health Plans. Many people use it to find several best-buys for them. Editor Walton Francis says most people can save lots of money — up to $2000 next year — if they pick the best deal from the dizzying array of health plans available to 4-million-plus federal workers, retired civil servants and their survivors.  Many of them have been in the same health plan for decades, And over time, as they get older and more dependent on health care, the plan has simply become too expensive (in premiums) based on what they get in benefits and services.

Places that subscribe to the service include the departments of Education, Interior, Justice, Labor and State. Also the Congressional Budget Office, U.S. Capitol Police, Federal Aviation Administration, Government Accountability Office, GOP and Office of Personnel Management. It is also available to members of the American Foreign Service Association, the Professional Managers Association and the National Treasury Employees Union. And more.

Francis estimates tens of thousands of workers — and an even larger number of retirees — could save thousands of dollars in premiums next year by switching to the standard or basic option of their current plan. Or save thousands by switching to a similar plan that also has your doctor(s) in its network. There are even plans with Health Savings Accounts that allow policy-holders to amass accounts worth $50,000 or more. But you gotta shop. The Office of Personnel Management also has an excellent online shopping tool that is available to all employees.

And if you prefer the Checkbook’s Guide or want to use it with the OPM online shopper, you can check if your agency subscribes for you.

Walt Francis will be my guest today at 10 a.m. EST  on the Your Turn radio program. That’s streaming at www.federalnewsnetwork.com or in the DC-Baltimore area at 1500 AM. If you have question for the expert (him, not me) send them to me at mcausey@federalnewsnetwork.com before showtime so we can answer them on air.

If your agency hasn’t subscribed for you, you can do it yourself by going online at www.guidetohealthplans.org; use promotion code FEDNEWS to get a discount.

On today’s show we’re going to cover.

• Ways to find plans to consider “side by side” with the plan you are in now.
• Using the FEHB as an investment option.
• New Medicare Advantage options within the FEHB.
• Best buys for seniors, young employees, people needing a specific coverage such as maternity, hearing aids, chiropractic.

Nearly Useless Factoid

By David Thornton

Many modern nicknames that seem to make little sense stem back to a Middle Ages practice of rhyming or letter swapping. Hence Richard is shortened to Ric(k), which rhymes with Dick. The same is true of Bill (William – Will – Bill) and Peggy (Margaret – Meggie – Peggy).

Source: MindBounce 

And the anti-HMO feeling many federal workers have could be costing them money in premiums and good service.

There are a wide array of HMOs available to federal workers/retirees during the current open enrollment period. It ends Dec. 13. Active and retired feds have plenty of plans and options to choose from. That includes traditional fee-for-service plans, like Blue Cross, GEHA and Aetna.

Despite the importance of actually shopping for the best deal during open season, experience shows that most people do nothing during the open season. They stay in the same plan they’ve been in for years. Even though that plan — excellent though it may be — has accumulated too many “heavy users” (older, more expensive) members, while younger, healthier people moved to other plans, or to the lower-premium standard or basic options of their favorite plan. Staying put for a long time — without shopping — means that many active and retired feds are now paying up to $2,000 more for the same coverage they could get with another option or plan. That’s the word according to Walton Francis, editor of Checkbook’s Consumer Guide To Health Plans for Federal Employees.

Francis says all of the plans in the Federal Employees Health Benefits (FEHB) Program are good. That includes fee-for-service plans as well as HMOs. But some, based on what you pay, are a better fit for you, your family and your lifestyle. And those things change over time.

So is an HMO for you? Francis cites these pros and cons you should consider when thinking about enrolling in an HMO:

Upside: HMOs come in two varieties. One, if a facility-based operation where most or all of the medical personnel and services are in one location. The other, called individual practice associations (IPAs), consist of different doctors in different locations. Both types usually offer good group consultation and coordination.

• Premiums and co-payments in many HMOs are lower than comparable fee-for-service plans.
• HMOs generally have systems for doctors to review each other’s practices.
• HMOs eliminate the inconvience  of submitting claims for costs and services. A major plus for many policy-holders.
• HMOs assure you access to a group of doctors,.
• They prevent a doctor from charging more than the plan will reimburse.

Downside: Many IPA plans often have participating physicians and hospitals but rarely a majority of those in the community, and rarely prestigious facilities — like the Mayo Clinic — in other states.

• Most group plans require you to go to one of their office locations except in emergencies.
• They limit your choice of phyisicians.
• Both types of HMO impose barriers to obtaining care as rapidly as you might like, such as wiats for the net avcailable appointment for non-urgent visits.
• Some HMOs, Francis writes, “rely very heavility on mid-level professionals such as nurse practitioners and physicians assistants.”

In many cases HMOs charge much lower premiums (in some instances half the premium of a non-HMO), and offer better catastrophic coverage (the limit to your amount) than many of the fee-for-service plans.

Things to consider is if your primary physician is in the network, do you like the idea of one-stop medical services and how important premiums, copays and paperwork to you.

Nearly Useless Factoid

By Alazar Moges

Source: White House

Federal workers, retirees or their survivors have 12 more days to pick the health plan that will cover them and their families next year. Depending on your inertia level, that is either plenty of time or an impossible deadline to make such a potentially life altering decision.

What if you or a family member are hit by COVID next year? Or if a tractor trailer hits your vehicle? Does the catastrophic coverage limit of the plan mean your out-of-pocket costs will be minimal? Or are you in a plan that won’t pay until you’ve shelled out tens of thousands of dollars? Although many don’t think about a worst case scenario when buying insurance, experts say that should be your number one focus.

Have you checked to see if benefits and the list of preferred providers in your current health plan are the same as those in lower-cost options of the same plan? What do the terms high, standard and basic option mean? Is the more expensive high option always better? (Spoiler alert: The answer is NO). In some plans, high option has come to mean one thing: Same benefits, much, much higher premiums. If you are missing out, and paying way to much for the same coverage, whose fault is that?

Federal workers, retirees and their surviving spouses are fortunate in many ways. They have a large number of health plans to choose from. The government will pay much if not most of the premium. No one can be turned down for any reason. Full coverage continues in retirement, which is not the case in most private plans.

While the choice of 20 to nearly 40 health plans and options is bewildering, it is an effort everybody should make. Many federal agencies have made it easier for people to shop at work, on the clock, by subscribing to Checkbook’s Guide to Health Plans For Federal Employees. The online guide makes it easy for people to check out plans, benefits, networks, catastrophic coverage and, of course, premiums.

The good news, for you and me, is that Walton Francis is my guest today at 10 a.m. EST on Your Turn. You can catch it streaming here or on the radio in the Baltimore-D.C. area at 1500 AM. The show will also be archived on our home page so you can listen later. But not too much later. Remember, the countdown clock is ticking and you’ve got skin — literally and in money — in this open season. Francis is the long time editor of the Checkbook Guide, which, if your agency hasn’t subscribed for you, you can get by clicking here. You can save an additional 20% with the promotion code FEDNEWS.

Today’s show is going to be about your choices, why you should probably change plans this year and hidden things most people don’t know about their choices — but that they should know. If you have questions for Walt, please send them to me before showtime at mcausey@federalnewsnetwork.com.

Walt will give you expert advice and guidance. Enough to help you save up to $2,000 in premiums next year, and how to turn your health plan into an investment option worth $50,000 or more.

Here are some of the subjects he will be touching on:

• Ways to find plans to consider “side by side” with the plan you are in now.
• Using the FEHB as an investment option.
• Avoiding fatal mistakes and the five-year rule, which could disqualify you for FEHBP coverage when you retire.
• New Medicare Advantage options within the FEHB. These can be win-win choices for many feds.
• Best buys for seniors, young employees and people needing a specific coverage).

Nearly Useless Factoid

By Alazar Moges

But two years into a pandemic, with a new potentially deadlier variant spreading fast, lots of people are paying lots more attention to their heath coverage. Or should be.

The open season for federal workers, retirees and survivors ends Dec. 13. Many could save thousands of dollars in premiums next year by considering a similar, sometimes superior, plan’s standard or basic options. Or enrolling in a high deductible plan where, with good health and a little luck, they can amass savings/investment accounts of $50,000 or more. Some Medicare Advantage plans can also save big bucks. And many people are happy with the health savings accounts.

But…

You have to shop around. If you’ve been in the same plan for 3-to-5 years, it may not be your best buy.

People buy health insurance for a variety of reasons. Low premiums or copayments. Their doctor is in the network. They are looking for prescription or dental coverage. Maybe they prefer a one-stop HMO operation. Whatever the reason.

Most do nothing and never even consider changing health plans.

But the primary reason people should buy health insurance is its catastrophic coverage. The amount you will have to shell out before the plan covers the rest of your costs. Costs from an accident or hospitalization. Medical bills are a major reason people go into bankruptcy. In times of a global epidemic, that is overridingly important.

So what do you do? You check the Office of Personnel Management’s excellent online guide. Many also like Consumer’s Checkbook Guide to Health Plans, which is so popular that many federal agencies (and at least one union) have joined it for their employees and members.

Checkbook will help you locate the best plans for you in your geographic area. And it gives great priority to the cost-to-you-limits of each plan in the event you have massively expensive medical bills next year. For a single person with a self-only plan, that out-of-pocket limit ranges from $4,000 to just over $10,000. For a family of three, the limit to you ranges from $8,400 to more than $19,000. Big difference.

Since the open season started, we’ve had a series of columns and Your Turn shows featuring Checkbook editor Walt Francis. The columns and shows are archived so you can read and/or listen anytime. Walt will be my guest again this Wednesday at 10 a.m. If you have questions for him about anything related to your health/family situation, send them to me at mcausey@federalnewsnetwork.com and I’ll ask him on air.

Nearly Useless Factoid

By Alazar Moges

There is red or pink colored snow that falls in certain icy areas, commonly refered to as watermelon snow, caused by a species of ice-loving algae known as Chlamydomonas nivalis. It even smells sweet and fruit-like, but experts say it is not wise to eat it because while not dangerous in small amounts, it is considered a laxative that can cause digestive issues.

Source: Ocean Conservancy 

But come Jan. 1, health care consumers, including federal employees and retirees, will see an end to a problem that isn’t necessarily a daily aggravation, but one that’s a real doozy when it does pop up.

In this case, the problem often happens when a patient goes to an in-network hospital but receives treatment from an out-of-network provider — and receives a hefty bill after the fact that he or she wasn’t expecting. Surprise bills are perhaps most common after emergency situations, maybe when anesthesiology is involved, said Walt Francis, a health policy analyst and author of the annual Consumer’s Checkbook Guide to Health Plans for Federal Employees.

“Of course you want your life saved; you’re not going to start quizzing physicians about what their charges are,” he said.

Congress last year found a way to protect Americans from surprise bills. Yes, amid the political squabbling, Congress is still capable to identifying a problem, doing some homework and passing legislation intended to resolve or least alleviate that problem.

In this case, the legislation was the No Surprise Act, which Congress included the 2021 omnibus spending package and former President Donald Trump signed into law late last December.

The Office of Personnel Management, along with the departments of Labor, Treasury, and Health and Human Services, have been releasing a series of new regulations that implement the No Surprises Act over the course of the last few months.

The new rules go into effect Jan. 1, and apply to almost all public and private health insurance plans in the country, including the Federal Employees Health Benefits Program. Medicare and Medicaid are already subject to  similar rules, which are quite complicated and lengthy.

But moving forward, emergency services, regardless of where you receive them and who performs them, must be treated as if they’re in-network.

Insurance companies can no longer charge out-of-network prices for ancillary care (like an anesthesiologist) at an in-network hospital.

Patient co-pays or deductibles for both emergency and non-emergency services must be treated as if they were provided in-network. And patients must provide consent to receive out-of-network care  before a doctor can bill at that higher out-of-network rate.

Francis said there still be a few minor loopholes, but by and large it’s a big deal.

“This is a big reform,” he said. “The anesthesiologist who’s not in any plan network may still be able to charge more, but the plan itself becomes an intermediary and does protect the patient from a surprise bill.”

“It’s one of life’s aggravations that’s about to go away,” Francis added.

Surprise billing doesn’t happen to everyone, but it’s common enough. In announcing the regulatory changes earlier this year, the Biden administration estimated one in every six emergency room visits and inpatient hospital stays involve care from at least one out-of-network provider, prompting a surprise bill.

Francis said it’s why health plans with bigger networks, like a Blue Cross and Blue Shield, are so popular. Feds like the peace of mind of knowing that if, for example, an emergency does come up, they can visit the hospital and feel reasonably confident that a majority of the doctors there are within their network.

Now, feds should have some more peace of mind, regardless of their health plan, the next time the unexpected happens. Those plans are responsible for ensuring their patients don’t get billed more than the normal rate.

Of course, these changes shouldn’t mean federal employees toss the basic rules of choosing an appropriate health insurance plan.

Francis suggests FEHB participants check with their doctors each year to ensure they’re planning to stay within their preferred network — and then do some research about what new benefits are coming to your current plan and the others.

The plans change every year, and nearly all insurance providers add new benefits or perks to compete with others and respond to OPM’s priorities for the FEHBP.

Of course, now is the time to check with your doctors and research those plans. Open season is happening now and runs through Dec. 13.

We’re still taking your open season questions and answering one or two each day on the The Federal Drive with Tom Temin. We can’t choose your health plan for you, but we can tap into our network of experts to answer any broad questions you might have about open season, the FEHB, etc.

Feel free to submit your questions here.

Nearly Useless Factoid

By Amelia Brust

In southwestern Australia, in the locality of Wellington Mill, a humble roundabout is home to thousands of gnome statues. Dubbed “Gnomesville,” the roundabout was originally protested by neighbors and the first gnome appeared without explanation. After a few months there were around 20, and over time the collection grew to create one of the country’s most popular tourist attractions.

Source: Atlas Obscura

Suppose just before your Thanksgiving gala begins, your mate, significant other or best friend says after dinner you two need to have THE TALK! Leaping giblets, that sounds bad, right?

But like so many things we dread, it turns out to be important, but not as ominous as we feared. In this case, the lets-talk-turkey alert involves your federal health plan. The open enrollment season ends Dec. 13, so you still have plenty of time to shop. And in most cases plenty of reasons. Starting with the physical and financial health of you, your family or anyone under your plan.

There is a good chance that the plan you’ve been in for years, which has served you well, isn’t your best/smart buy. Plans and premiums change a lot. So does the population of that plan. And if it’s a high-option, odds are it has lots of older, sicker members. And that drives prices up. The experts say many people can save a ton by switching to a less expensive plan. Or the basic or standard option of their current plan.

Since open season started, we’ve had a series of columns listing the best buys for feds, postal workers, retirees and their survivors. There will be more to come. And we’ll have health plan expert Walton Francis each Wednesday on Your Turn to talk about the different plans. And if you have some downtime today or tomorrow, get on your computer and check out some of those columns. And the website of the Consumers Checkbook Guide to Health Plans.

Do a little shopping now and save a bundle next year. And maybe get even better coverage.

Happy holiday. See you next week!

Nearly Useless Factoid

By Alazar Moges

A German man named Andre Ortolf holds the record for most mashed potatoes eaten in one minute at 1120 grams. He set the record in Augsburg, Germany on 30 November 2017.

Source: Guinness World Records

Tired of shelling out thousands of dollars each year for your federal health plan? Confused, irritated or both by the multiple-choices available under the Federal Employee Health Benefits (FEHB) Program? Why not consider picking a health plan that pays you? Thousands of federal and postal workers have done it. Joined a high deductible health plan that has allowed them to amass accounts — their very own money — worth $10,000 to $50,000.

Welcome to the federal benefits open season, which runs through Dec. 13.

If you do nothing — that is remain in the same plan year after year — you could easily wind up paying $1,000 extra in premiums next year if you are single, and $2,000 or more if you have a family plan. If so, there is a relatively simple solution. Switch to a similar, lower premium option of your current plan. Or to a different plan with similar benefits but much lower premiums.

It may also be time to explore plans that offer flexible spending accounts (FSAs), health savings accounts (HSAs) and other options that weren’t available since you last shopped.

Sticking with the same plan year-after-year means lots of people are paying thousands of dollars too much, according to insurance expert Walton Francis. He says many could get similar, and in some cases, superior coverage by switching to a similar health plan or the standard or basic — as opposed to the high option — in their current plan. In some cases people can actually get better coverage by joining a plan with lower premiums.

Francis is the person who first referred to the high deductible federal health plans as Roth IRAs on steriods. A way to build a tax-free nest egg with free money! The high deductible plans are a good example of things many people should at least consider instead of sleep walking during another open season.

Because of their high deductibles, some plans have premiums that tend to be on the low-side of the 30-plus plans available federal workers, retirees and their survivors. As with other plans in the FEHB program, Uncle Sam will pay roughly 70% of the premiums. For life. Many private sector plans offer lower premiums but drop workers when they retire or become eligible for Medicare.

Shopping for health insurance is a pain, at best. But it is definitely worth it. Especially if you have an expert guide. Somebody like Walton Francis, who, along with Kevin Moss, edits the Consumers’ Checkbook Guide to Federal Health Plans. The book is $15.95 on newsstands. If you can find a newsstand. Many prefer the online version, which is more flexible and user-friendly. Many federal agencies now subscribe to it for their employees. If not, you can purchase it and get a 20% price cut if you mention FEDERALNEWS.

What’s the single most important reason to buy health insurance? Two very important words: catastrophic coverage. What if 2022 is the worst medical year in history for you or your family? An accident, a wreck, a major disease. According to Checkbook’s ranking system, a family of three has a catastrophic limit that would be just under $9,000 in the Kaiser high options plan vs. between $15,000 and more than $18,000 in some other plans. Whatever else you do (or don’t do) during this open season, check the limit-to-you amount of each plan you consider.

Other things to think about include how to save on taxes when paying your medical bills, and a half dozen items you probably hadn’t thought of but should consider. Which is why today’s Your Turn episode is a must-listen. If not today at 10 a.m. EST, then later on after it is archived on our home page. It could be the most productive 40 minutes of your year. For you and your family.

If you have questions for Walt Francis send them to me before showtime at mcausey@federalnewsnetwork.com and we will have the most cost-effective, safe, anwer for you.

Nearly Useless Factoid

By Alazar Moges

According to Guinness World Records, the heaviest turkey ever recorded weighed in at 86 lbs. in December of 1989. The turkey belonged to Philip Cook of Peterborough, United Kingdom.

Source: Guinness World Records

Access to better health is just a click away with UnitedHealthcare. The nation’s largest health care company is connecting millions of federal employees with virtual care options and technology they can use, like Peloton and Apple Fitness+.

As we continue to navigate the COVID-19 pandemic, one thing is clear; virtual care is here to stay. “The pandemic has accelerated the adoption of virtual care, both among consumers and healthcare providers,” said Samantha Baker, Vice President of UnitedHealthcare Consumer Digital Health. “During 2021, virtual care appointments were up 2,800 percent from the comparable period before COVID-19 started,” said Baker.

Virtual care or “telehealth” is the alternative to in-person visits, allowing consumers the flexibility to address preventative care, chronic diseases, and even mild emergency care visits from the comfort of their homes.

“Federal employees who select a United Healthcare plan will have access to virtual care through local care providers and our national telehealth network, at no additional cost,” said Baker.

To simplify the virtual experience, UnitedHealthcare has expanded its digital resources to include
personalized onboarding videos, a step-by-step breakdown of coverage and easy access to claims and
online payments, and more.

“UnitedHealthcare is focused on making the mobile experience better, so you can easily get the
answers to the questions you have and access to care with the click of a button,” said Baker.

An exciting new perk offered to new and existing plan members is access to fitness apps, Peloton and
Apple Fitness+.

As of September 1, 2021, UnitedHealthcare members can get a free year-long subscription to the Peloton App. The app connects members to thousands of live and on-demand fitness classes, like strength, yoga, meditation, outdoor running, and more – all without the need for equipment.

In addition to the Peloton App, UnitedHealthcare members will also gain access to a free twelve-month subscription to Apple Fitness+, the first fitness service powered by Apple Watch. Apple Fitness+ provides studio-style workouts through the iPhone, iPad, or Apple TV, making instructional
exercises accessible anytime and anywhere.

And that only scratches the surface.

“We have so much planned for the future,” said Baker. “UnitedHealthcare is committed to using technology to improve health outcomes and make the healthcare system easier for everyone.”

As federal employees make benefits decisions during open season, which runs from November 8 to December 13, they are encouraged to evaluate all aspects of plan options, including cost, coverage, and the types of digital resources available.

To learn more information about UnitedHealthcare and select a plan that fits your healthcare needs, visit UHCFEDS.com.

Thanks to the federal benefits program, many retirees are at least as comfortable and financially secure as their private sector counterparts. But many aren’t, and some find the otherwise attractive benefits program — especially the health insurance part — confusing if not bewildering.

Many feds, especially if they have been retired for a few years, have been in the same health plan for a long time. Meaning there is a good chance they picked and stayed with a plan — while an excellent deal at the time — is now too expensive for them. In some cases retirees/survivors are paying $1000 to $2000 more per year, when they could get the same (in some cases actually better) coverage by switching from their current plans high option into its standard or basic plan. Similar coverage. Much lower premiums.

But with 30-plus plans to choose from, many working feds and retirees go into shutdown mode and do nothing during the annual health insurance open season. This year it ends on Dec. 13. But that won’t help if you don’t shop around. Inertia is easy.

This year retired feds and spouses have another attractive (or annoying) option. A Medicare Advantage plan. One that coordinates with various FEHB plans to cut premiums, improve drug coverage, etc. But where to start?

The Medicare Advantage ads are everywhere. There are lots of options. But you need to start somewhere. Like today. The National Active and Retired Federal Employees (NARFE) Association is offering an online guide that is free to NARFE members and costs $48 for non-members, which includes a one-year membership in NARFE.  The session is live today at 2 p.m. for those who are ready. And it can be repeated anytime if you are not ready today. Federal benefits expert Tammy Flanagan recommends it highly to retirees, whether in or out of NARFE. She realizes how difficult it is to shop and compare.

Here’s how NARFE and Tammy, explain it:

As an active or retired federal employee, turning 65 means two important things: You’re eligible for health coverage under both FEHB and Medicare, and you have a once in a lifetime opportunity to change health plans outside of Open Season—this can be your “do-over” if you want to change to a different plan before the next year. Some FEHB plans provide a health fund or Medicare reimbursement, while others waive cost sharing and have lower premiums. Many work well for couples who are over and under age 65, but plans can be expensive. The big question is: Are they are worth it?

With so many choices, figuring out the right balance of coverages can be confusing. Let NARFE federal benefits expert Tammy Flanagan help remove the guesswork from your decision as she shows you:

• How individual FEHB plans work with Medicare Parts A & B
• Which plans provide significant incentives to enroll in Medicare Part B
• How the prescription drug benefits compare with the most popular FEHB plans
• How to change health plans once you are eligible for Medicare
• And much more

A live Q&A session will follow the NARFE live presentation.

Coordinating your health plan with Medicare is the key to keeping your cost down and ensuring you’ll have the best possible coverage. Let NARFE show you the way with this valuable learning experience.

Here’s a direct link to register for Thursday’s Medicare and FEHB webinar: https://new.narfe.org/so-many-choices-which-fehb-plans-work-best-with-medicare-a-b/

Nearly Useless Factoid

By Alazar Moges

Source: World Atlas

Before you answer, your first question might be “what’s a Joe Namath?” or “what’s this Medicare Advantage thing?”

If you are of a certain age, and like (or hate) professional football, you will know that Joe was a very famous, successful college and professional quarterback. Now he is best known for TV commercials telling seniors how to get the most out of Medicare. And he is not alone.

Commercials touting the many advantages (no pun intended) of purchasing one of the growing number of Medicare Advantage plans are all over the place. They are mostly amusing, or ignored, by younger viewers. And they are an irritant or mystery to folks already on Medicare in some form. And that’s especially true for federal workers, retirees and their survivors. Under the Federal Employee Health Benefits (FEHB) Program folks have the choice of 30 plus plans and options. It is an excellent but bewildering choice. And that wide array of choices is the primary reason many feds and most retirees stay in the same plan year-after-year. And wind up paying much more in premiums than they have to. In some cases up to $2,000 per year more.

The FEHB open season runs through Dec. 13. so there is still plenty of time to compare plans, in addition to your current carrier, and compare their premiums, benefits, drug coverage and physician network. For folks trying to navigate the world of Medicare and FEHB benefits, it is even more complicated. Unless you have an expert at hand which, if you are reading this, you do. Spoiler alert: I am not the expert. Not even close. But I know who is. That would be Walton Francis, long-time editor of Checkbook’s Guide to Federal Health Plans. And he’s going to be my guest today on Your Turn. The show will be streaming live at 10 a.m. EST or on the radio at 1500 AM in the Washington D.C.-Baltimore area. The show will also be archived so you can listen anytime, or pass it on to a friend.

Walt Francis will also be answering questions you may be (or should be) asking. For instance:

• Want to learn about the latest changes affecting your health insurance options? We will cover those, including the new Medicare Advantage options available to annuitants with Medicare Parts A and B.
• Want to learn about how even the most controversial subjects, like health insurance laws, can lead to bipartisan outcomes? We will cover the new “No Surprises” law.
• Want to learn about how smart insurance and benefits choices can be worth tens of thousands of dollars over the long haul? We will cover:
  • When does a Roth IRA save you thousands of dollars a year in insurance premiums?
  • When does a High Deductible health plan provide not just good health insurance, but also an investment method worth thousands of dollars a year?
  • When is Medicare Part B almost free while saving you thousands of dollars a year in medical costs?

Plus, as always, the Checkbook’s recommendations for saving thousands of dollars just by picking a plan that is a good buy.

If you have specific or general questions send them to me before showtime at mcausey@federalnewsnetwork.com.

Nearly Useless Factoid

By Alazar Moges

There have been eight left handed presidents in U.S. history. They were James A. Garfield, Herbert Hoover, Harry S. Truman, Gerald R. Ford, Ronald Reagan, George H. W. Bush, Bill Clinton (who was the third in a row) and Barack Obama.

Source: GovTech

Enough book critic! Now to the point.

Although some feds will be on the job, as per usual today, many more will be off. A mid-week break. And a perfect time to shop — from home or office — for your 2022 health plan.

Things change. Premiums go up and down, mostly the former. Your status and finances may have changed since the last time — which may also have been the first time — you picked a health plan. This year, the government makes it even easier to shop, via the OPM website or the Consumer Checkbook online guide.

Checkbook’s editor Walton Francis says that many feds and retirees are paying $1,000-to-2,000 more each year than they need to. Many are in the same high option plan they first picked. But things — benefits, premiums and plan networks — have changed. He estimates many if not most feds and retirees could save money by shopping for a less costly plan. That was the subject of yesterday’s Your Turn show with Francis as the guest. If you missed it, or would like to hear it again, simply click here.

To prep you for your shopping, here’s Walt’s tip sheet:

As always the main things are…

Compare, compare, compare. Many easy ways to do it, including the Checkbook web site, OPM web site, plan websites and plan brochures downloaded from any of these sources.

Looking for big savings? Most feds could save $2,000 or more next year. Think of such savings as a longer term investment. $2,000 a year is $10,000 over five years.

Too confusing to compare up dozens of plans in the D.C. area? Narrow your choice quickly. Look for lower-priced options from the same carrier you now use.

Nearly Useless Factoid

By Alazar Moges

The United States makes up 21% of the world’s total oil consumption. Followed by China at around 14% and India at around 5%.

Source: U.S. Energy Information Administration

Federal workers and retirees have little time to miss another deadline and lose, as in overpay up to $2,000, on next year’s health premiums. All they have to do to ensure loser status for insurance premiums is nothing. Ignore open season (which runs through Dec. 13). Stay in the same health plan you’ve belonged to since the Carter administration. Don’t even consider leaving the high or standard option of your favorite plan since Friends or the Fresh Prince of Belair topped the TV charts.

Although lots of things have changed since you last seriously shopped for the best health plan, tens of thousands of feds and even more retirees have let inertia rule. They’ve either failed to compare plans and benefits — which have changed dramatically — or stuck with a Cadillac (high option) version when they could be paying a lot less and getting similar benefits by switching to their plan’s “basic” option. Or to another just-as-good plan with lower premiums. And which also has their favorite doctor in their PPO network.

Feds and retirees on average will pay nearly 4% more in premiums beginning in January. But that’s an average of the 30-plus plans and options available to most people. Federal retirees will be getting a 5.9% cost of living adjustment next year if they are under the old Civil Service Retirement System. CSRS retirees will get 4.9%. Federal workers are due a 2.7% raise in January. So everything’s going up. Some more than others. But there are things that feds, postal workers and retirees can do that will shave anywhere from $1,000 to $2,000 from their health premiums next year. IF they shop. And IF they find a better plan. And IF they leave the loving (but expensive) arms of their health-plan-for-life and check out the field and choices for 2022. It isn’t easy and it isn’t (unless you enjoy self-torture) fun. But it is worth it to look. For example, some plans will have big changes, or higher (or lower) premiums. But you won’t know which until you know where to look. Some plans will make it less expensive for the policy-holder to get self-plus one rather than a family plan. Some married-to-a-fellow-fed will find it might be less expensive to get two self-only plans. At times. And in some cases, much more expensive if they pick two plans and must meet two deductibles.

Most private sector companies offer minimum choices, minimum premium sharing and zero help to workers during their open seasons. Not Uncle Sam. When it comes to a helping health plan hand, the federal government can’t be beat. The Office of Personnel Management offers an excellent website which helps workers navigate the various plans, options and premiums. Most agencies now offer (free to employees) the Consumer Checkbook guide to federal health plans. Its long-time editor Walton Francis sorts out the best deal for workers, retirees or survivor annuitants. You can check to see if your doctor is in network and find out other things that should be a factor in deciding on your 2022 health plan.

To kick off open season, Walt Francis will be my guest today at 10 a.m. on Your Turn. He’ll answer questions and give you a checklist of what to do during this open season. That will include things like health plans that offer HSAs (health savings accounts) for employees. Some of them who have been in HSA plan for years now have accounts of $50.000.

If you can’t listen today, or want to hear it again or alert a coworker or friend, the show will be archived on our website. So listen today, tomorrow, whenever.

For today’s show, if you have questions for Walt Francis send them to me ASAP at mcausey@federalnewsnetwork.com.

Whatever you do this open season, make sure it isn’t nothing!

Nearly Useless Factoid

By Alazar Moges

Source: Britannica

Participants in the Federal Employees Health Benefits Program (FEHBP) can expect to pay, on average, about 3.8% more toward their health premiums in 2022, the Office of Personnel Management announced back in September.

Overall premiums will go up — again, on average — 2.4% next year, with the government’s share rising by about 1.9% in 2022.

That’s actually a relatively modest bump, at least compared to recent years. FEHB participants paid an average of 4.9% more toward their health plans for 2021 and 5.6% more for the previous year.

Rates back in 2016 were even higher.

So far nothing can top 2019, when FEHB participants paid just 1.5% more toward their health insurance. It was the smallest overall rate increase since 1996 and the lowest premium hike for participants since 1995. Take the small victories in life.

For 2022, OPM calculated what this information would mean for the average employee’s paycheck.

Assuming non-postal federal employees receive a 2.7% pay raise as planned, OPM estimated the average worker will earn a biweekly salary of $3,599 next year. Health insurance, on average, will cost employees $171.74 for each pay period, or roughly 4.8% of their salaries, OPM said.

That’s slightly more than the current year, where biweekly salaries averaged $3,504 for each pay period and employees paid $165.52 toward health insurance in 2021, or 4.7% of their salaries, OPM said.

It’s worth repeating again; these are averages. Rates are going up for some plans in 2022, while some will actually go down.

A participant enrolled in Blue Cross and Blue Shield Basic will pay $3.42 more every month for insurance, with an employee enrolled in the family plan paying $23.88 more per month.

The Blue Cross and Blue Shield standard plan will go up $8.71 a month for individual participants and $30.31 for families.

But the cost of a Government Employees Health Administration (GEHA) plan for one will dip by $7.11 a month, with monthly rates for a family plan dropping by $25.74, according to OPM.

OPM sets premium rates for a given year based on how federal employees and retirees used the health care system during the prior year.

Sure, the rising costs of treating chronic illnesses, prescription drugs and advances in medical technology continue to drive health care prices up, OPM has said.

But the pandemic continues to make predicting annual FEHB premium rates difficult, to say the least.

Some carriers told OPM that the costs of treating and testing COVID-19 patients had an impact on their rates, though perhaps not a huge one in the grand scheme of things.

COVID-19 tests and treatment cost the FEHBP about $1 billion in 2020 and represented about 2% of the program’s claims.

OPM said it anticipates those costs will eventually go down, especially as more employees get vaccinated.

When asked for more details on why the 2022 rates stayed relatively modest, OPM told us:

“Actual 2020 trends were less than projected when 2021 rates were being set, largely due to the unknown future trajectory of the COVID-19 pandemic,” the agency said. “2022 rates incorporate actual 2020 trends and 2021 experience to date, as well as projections of costs throughout the remainder of the year and into 2022. The 2022 rate increase was also offset by expected savings through several carrier renegotiations with their pharmacy benefit managers.”

In other words, feds used the health care system less frequently during that initial year of the pandemic as they delayed elective surgeries and other semi-optional procedures.

That’s starting to change. OPM said it’s beginning to see FEHB participants file more claims as they make more regular doctor’s visits or schedule procedures they initially delayed. That trend will likely continue into 2022 and could impact premiums in future years.

“We’re still in a unique situation with the pandemic,” Greg Klingler, chief operating officer of the Government Employees’ Benefits Association (GEBA), told me. “We’ve really never seen a pandemic like this since I guess 1918, and obviously the FEHB plan wasn’t in effect at that time. I think everyone’s treading new waters here.”

If that all sounds a little overwhelming, stay focused on the here and now. Federal employees and retirees have an annual opportunity to review their health plans through open season.

That starts Monday and runs through Dec. 13. Take a look at the full plan brochures, which are live now on the OPM website here. You can also use the agency’s plan comparison tool here.

And for another year, we’re opening up our open season hotline, where you can submit your own questions. We’ll answer one question each day on the Federal Drive with Tom Temin. We can’t get to every question, but we’ll do our best to answer as many as possible.

Nearly Useless Factoid

By David Thornton

Spiders can have arachnophobia.

Source: NPR

People are going back to the dentist in full force to regain control of their oral health. Open Season is the best time to reexamine the dental plans available to federal employees and TRICARE retirees, as plans and premiums may be changing.

One change of note is from a popular mid-Atlantic dental plan that is making some significant enhancements that will generate some buzz among feds. Dominion National, which has offered the only Dental HMO (DHMO) plan available to FEDVIP participants since 2014, is upgrading its offering to an Exclusive Provider Organization EPO plan.

What is a Dental EPO and what does this change mean?

“Our dental EPO plans include predictable, pre-determined fees and are designed for transparency for members and dentists in that there are specific copayments listed for each covered service. If you know what dental procedures you need to have completed, you will know how much you will pay for your dental care before you even go to the dentist,” said Mike Davis, Dominion National president. “Dominion’s EPO also provides immediate access to care, meaning no waiting periods, no annual maximum limits and overall just the peace of mind that you don’t have to worry about unexpected costs.”

When looking at dental options, it’s important to look at price, coverage and dental network access. While Dominion’s EPO plans are competitively priced and cover preventive, basic and major restorative care, dental network access has dramatically increased and has more than doubled the number of participating dentist listings. Additionally, enrollees may now receive services from any in-network dentist without having to select a primary care dentist.

Contrast that with a PPO, which covers a percentage, or coinsurance, of the total cost. But the total cost could vary depending on where the procedure is performed. For example, the average cost of a crown in the Washington, D.C. area is about $1,500. An enrollee using a PPO would have to contact his or her dental office to discover that price; the PPO only reveals the percentage it pays. The EPO, on the other hand, ensures participants get the same fixed price as participating Dominion dentists agree to the same contracted fee, and that cost is revealed upfront.

An EPO does require participants to stay in network, which is how it can offer those prices while keeping premiums lower. A PPO offers more flexibility to go outside the network. That element of choice is attractive to some participants – particularly if they have a relationship with their dentist and want to ensure they can continue receiving care from their dentist. It is important to consider if you will need to go outside the network in your dental plan evaluation. PPOs might make sense for someone who travels a lot, which could make it hard to stay in network. However, if your dentist participates in an EPO network and you plan to receive dental treatment locally, an EPO might make sense if you are looking to pay a lower premium.

Why reevaluate your options?

Your dental needs may change each year. Some years may be focused on preventive care like cleanings and exams, which are offered with the standard option plans. However, others may need more restorative care such as crowns, root canals or implants, which are likely covered at a higher level with high-option plans.

In addition, dental health has been linked to overall health in a number of studies, which have linked gum disease to oral cancer, heart disease, diabetes, respiratory ailments, preterm birth, skin diseases, thyroid problems and leukemia.

“We conducted a study with Capital BlueCross and Geneia, LLC, which associates receiving recommended preventive dental care with reduced emergency room visits, hospitalizations and medical claims costs for people with chronic medical conditions,” Davis said. “Minimizing emergency room visits and in-patient hospital stays can be associated with significant savings on medical expenses. Dental can help play a role.”

That’s why Dominion National created an incentive plan to help encourage participants to get regular dental checkups.

“Each family member enrolled with Dominion who receives two cleanings during the plan year will be reimbursed for their $10 office visit copayments made to the dentist at the time of service – a total reimbursement of $20 per family member. We submit a check for the reimbursement to the primary subscriber,” Davis said. “This has been very well-received and can move the dial on member satisfaction and retention.”

Also, when choosing your dental plan don’t forget to look at other value-added services and discounts that may be available with your plan. For example, Dominion National now offers discounts on Invisalign, SmileDirectClub’s clear aligner program and teeth whitening procedures. Due to increasing consumer demand from the pandemic, Dominion also covers teledentistry services.

When and where to enroll

This year’s Federal Employees Dental and Vision Insurance Program (FEDVIP) open enrollment season for choosing a dental plan runs from Nov. 8, 2021, through midnight EST Dec. 13, 2021, for coverage effective Jan. 1, 2022. FEDVIP is available to Federal employees, retirees, TRICARE retirees and their families.

For more information on Dominion National’s EPO, visit FederalDentalPlans.com. There you can review plan information, find a dentist, view an enrollment video and see a list of FAQ’s. To enroll, go to BENEFEDS.com.