Big News For Those On FEHB BCBS And Other Plans

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Topic Author
tallguy3891
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Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

Heads up! As mentioned elsewhere, FEHB plans were given the opportunity to allow plans to offer those enrolled in FEHB and Medicare additional Rx options. These are through Medicare Part D.

I see that 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.

The Rx tiers/cost are different from the regular BCBS Rx.

Also, this option has a yearly cap on out of pocket so that seems to be a good perk.

I'm guessing other FEHB plans will also offer these at some point.

Again, these are through Medicare Part D (although perhaps not the publicly offered ones).

Any comments?
Last edited by tallguy3891 on Sun Oct 01, 2023 6:49 pm, edited 1 time in total.
chalet
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by chalet »

Why do you say that plan is Part D? I saw nothing on the webpage about Part D.

https://www.fepblue.org/medicarerx
HoneyBee
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HoneyBee »

I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.

It looks like the primary advantage of this new plan is a cap on ones annual out of pocket RX costs at $3250 a year. And perhaps $5 less in co-pays for some of the drug Tiers but a higher copay for specialty drugs.

Will the drug formularies be different? Because currently the BCBS medical plan covers certain medical expenses that Medicare does not cover, like an annual physical.

I don't take many prescription meds so this does not seem to affect me. Maybe I am missing something.

I have long said that if the FEHB really wanted to encourage federal gov't retirees to sign up for Medicare, they should have much lower premiums for those who are paying for Part B. Once you go on Medicare Part B, it becomes primary and BCBS pays next to nothing. Yet they only rebate members $800 a year (if you jump through all the hoops to get the rebate.)
chalet
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by chalet »

HoneyBee wrote: Sun Oct 01, 2023 5:14 pm I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.
the coming Part D changes may have FEHB providers concerned.

a combination of high deductible G medigap and a capped Part D plan...... could be competitive with a BCBS plan.

assuming A and B primary in both cases.
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

chalet wrote: Sun Oct 01, 2023 4:41 pm Why do you say that plan is Part D? I saw nothing on the webpage about Part D.

https://www.fepblue.org/medicarerx
If you go to the 2024 brochure, Section 5 for Prescription benefits, scroll down below regular Rx benefits and there is a specific section about the new MPDP option. It states it is Part D in the first part.

https://www.fepblue.org/open-season/-/m ... A525739959
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

HoneyBee wrote: Sun Oct 01, 2023 5:14 pm I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.

It looks like the primary advantage of this new plan is a cap on ones annual out of pocket RX costs at $3250 a year. And perhaps $5 less in co-pays for some of the drug Tiers but a higher copay for specialty drugs.

Will the drug formularies be different? Because currently the BCBS medical plan covers certain medical expenses that Medicare does not cover, like an annual physical.

I don't take many prescription meds so this does not seem to affect me. Maybe I am missing something.

I have long said that if the FEHB really wanted to encourage federal gov't retirees to sign up for Medicare, they should have much lower premiums for those who are paying for Part B. Once you go on Medicare Part B, it becomes primary and BCBS pays next to nothing. Yet they only rebate members $800 a year (if you jump through all the hoops to get the rebate.)
I haven't seen any formulary or pricing tool for it for 2024 yet.

The big thing right now is to know that those already on Standard, Basic, or Focus will be automatically enrolled in the new Part D MPDP for 2024. Apparently a notification will be going out and then one has a limited time to opt out of it and back into the regular Rx part.

If I were still on BCBS, I would definitely check pricing of all meds with the pricing tool when it is available for 2024 to make sure costs did not change a lot in the regular Rx due to this.
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

chalet wrote: Sun Oct 01, 2023 5:31 pm
HoneyBee wrote: Sun Oct 01, 2023 5:14 pm I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.
the coming Part D changes may have FEHB providers concerned.

a combination of high deductible G medigap and a capped Part D plan...... could be competitive with a BCBS plan.

assuming A and B primary in both cases.
I'm not sure how the funding works, but this seems like a win-win for FEHB insurance companies. They are paid a large amount between the premium and what the gov't pays, and now they are maybe paid another Part D subsidy(?) with these (MPDP) plans and the plan does not have to cover the regular Rx cost?

In addition, annuitants on Medicare are still paying full FEHB rates when on Medicare A/B even though the FEHB plan is paying a smaller fraction of costs.

I agree that they should offer premiums which are much less for those on Medicare, especially considering some self+one plans are approx $700 or more per month in addition to Part B premiums.

Your comment about Medigap + D is interesting. It could be cheaper per month, have better skilled nursing coverage (SNF), and sometimes better Rx coverage. BUT, the big problem is it would mean canceling FEHB and that in general consensus is a huge mistake because one cannot get back on FEHB once that is done. I would never recommend it.

Having said that, there are Medicare Advantage plans in my area which have zero to low premiums, good Rx coverage in my opinion, and better SNF coverage than many FEHB plans I have seen which cost hundreds per month. Apparently one can suspend FEHB to enroll in a Medicare Advantage plan, or, if I understand Section 9 of the FEHB brochures correctly, even remain on a FEHB plan and enroll in a Medicare Advantage plan as well. I have never gotten a clear answer on this. Perhaps then the Advantage plan becomes primary and the FEHB plan becomes secondary?
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

More info regarding FEHB plans for 2024, including new Medicare Advantage plans and Part D options.

https://www.opm.gov/healthcare-insuranc ... lights.pdf
mbres60
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by mbres60 »

We (dh and I) each received in the mail today a letter from Aetna. It starts by saying To all federal enrollees of Aetna Open Access Enrollment code HA. We get our mail late so are just going over it. It certainly implies that this was meant for us. After looking at the link that tallguy3891 provided, I realized it was not. Apparently this plan is in Kansas City area. We are not in that state and have Aetna Direct. They really scared us! I was envisioning having to do a LOT of research and spending time listening to webinars (NARFE will be having some) when I was just planning to do some research to understand the new Rx stuff. I don't know why they didn't just send it to those in that plan. Maybe soon we will get another letter saying Oops!

Anyone else get this letter?
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

mbres60 wrote: Mon Oct 02, 2023 7:36 pm We (dh and I) each received in the mail today a letter from Aetna. It starts by saying To all federal enrollees of Aetna Open Access Enrollment code HA. We get our mail late so are just going over it. It certainly implies that this was meant for us. After looking at the link that tallguy3891 provided, I realized it was not. Apparently this plan is in Kansas City area. We are not in that state and have Aetna Direct. They really scared us! I was envisioning having to do a LOT of research and spending time listening to webinars (NARFE will be having some) when I was just planning to do some research to understand the new Rx stuff. I don't know why they didn't just send it to those in that plan. Maybe soon we will get another letter saying Oops!

Anyone else get this letter?
No letter yet, but my opinion is to be careful. According to the booklet in the link, page 18, Aetna Direct will be one of the plans offering the new Part D Rx in their regular plan, and from what I have seen so far, those on the plan already might be automatically enrolled in the Part D Rx. I am hoping they will also offer the option to opt out to be able to go back into the regular plan Rx. I think this 2024 open season will require careful reading of the applicable FEHB brochure, especially the sections on changes for 2024, prescription coverage, and section 9 on Medicare.
mbres60
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by mbres60 »

tallguy3891 wrote: Mon Oct 02, 2023 9:43 pm
mbres60 wrote: Mon Oct 02, 2023 7:36 pm We (dh and I) each received in the mail today a letter from Aetna. It starts by saying To all federal enrollees of Aetna Open Access Enrollment code HA. We get our mail late so are just going over it. It certainly implies that this was meant for us. After looking at the link that tallguy3891 provided, I realized it was not. Apparently this plan is in Kansas City area. We are not in that state and have Aetna Direct. They really scared us! I was envisioning having to do a LOT of research and spending time listening to webinars (NARFE will be having some) when I was just planning to do some research to understand the new Rx stuff. I don't know why they didn't just send it to those in that plan. Maybe soon we will get another letter saying Oops!

Anyone else get this letter?
No letter yet, but my opinion is to be careful. According to the booklet in the link, page 18, Aetna Direct will be one of the plans offering the new Part D Rx in their regular plan, and from what I have seen so far, those on the plan already might be automatically enrolled in the Part D Rx. I am hoping they will also offer the option to opt out to be able to go back into the regular plan Rx. I think this 2024 open season will require careful reading of the applicable FEHB brochure, especially the sections on changes for 2024, prescription coverage, and section 9 on Medicare.
I agree that careful reading will be involved. I'm just so relieved that I don't have to do that in conjunction with searching for a new plan altogether!!! I must say though that I do pay attention to some webinars etc to see if we should be switching but some years not so much. This year I am busy with other things and don't want to have to spend too much time doing this.
Richard8655
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Richard8655 »

I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
UpperNwGuy
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by UpperNwGuy »

I got an email from BCBS FEP Medical advising me of this change. I still don't understand "What's in it for me?".
Asyouwish
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Asyouwish »

mbres60 wrote: Mon Oct 02, 2023 7:36 pm We (dh and I) each received in the mail today a letter from Aetna. It starts by saying To all federal enrollees of Aetna Open Access Enrollment code HA. We get our mail late so are just going over it. It certainly implies that this was meant for us. After looking at the link that tallguy3891 provided, I realized it was not. Apparently this plan is in Kansas City area. We are not in that state and have Aetna Direct. They really scared us! I was envisioning having to do a LOT of research and spending time listening to webinars (NARFE will be having some) when I was just planning to do some research to understand the new Rx stuff. I don't know why they didn't just send it to those in that plan. Maybe soon we will get another letter saying Oops!

Anyone else get this letter?
Yes and I have Aetna Direct with FEHB.

However, a few days ago we received another letter telling us the first letter was issued to us in error. Oops.
mbres60
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by mbres60 »

Asyouwish wrote: Mon Oct 16, 2023 6:32 pm
mbres60 wrote: Mon Oct 02, 2023 7:36 pm We (dh and I) each received in the mail today a letter from Aetna. It starts by saying To all federal enrollees of Aetna Open Access Enrollment code HA. We get our mail late so are just going over it. It certainly implies that this was meant for us. After looking at the link that tallguy3891 provided, I realized it was not. Apparently this plan is in Kansas City area. We are not in that state and have Aetna Direct. They really scared us! I was envisioning having to do a LOT of research and spending time listening to webinars (NARFE will be having some) when I was just planning to do some research to understand the new Rx stuff. I don't know why they didn't just send it to those in that plan. Maybe soon we will get another letter saying Oops!

Anyone else get this letter?
Yes and I have Aetna Direct with FEHB.

However, a few days ago we received another letter telling us the first letter was issued to us in error. Oops.
We did too!
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

UpperNwGuy wrote: Mon Oct 16, 2023 5:12 pm I got an email from BCBS FEP Medical advising me of this change. I still don't understand "What's in it for me?".
A number of the FEHB plans are offering the new Part D Rx, and actually are automatically enrolling those on their plans in the new Part D option, BCBS among them. Letters are supposed to be sent out about the process of opting back into the regular plan Rx.

I have looked at a number of plans, and they seem to each be different. For instance, they put an out of pocket yearly cap for Rx in varying amounts which is nice for those on expensive meds.

BCBS FEHB Part D plans are also a little cheaper cost or tiers restructured. Aetna Direct appears to offer a nice Part D option--more set coinsurance/copay versus %. NOTE: For those on Aetna Direct---I spoke with a rep and she told me the fund received each year which automatically deducted Rx costs under the regular plan WILL NOT do so under the Part D option. The fund is still given but one would have to request reimbursement for Rx costs paid and/or Medicare premiums paid. This was disappointing news to me. I am on Aetna Direct and really like the automatic payment for Rx from the fund in the regular plan.

NALC High is also apparently offering a $600/$1200 reimbursement fund with their Part D plan. Other plans' Part D info can be seen at their respective sites as of now or soon to come.

My emphasis here is that 1) different plans' Part D are different, and most importantly, current enrollees in these plans will be AUTOMATICALLY enrolled in the new Part D options so don't get caught by surprise! There will be a window of time to choose to opt back into the regular Rx option of the plans. Some of the plans I believe have stated one can opt back to the regular plan Rx at anytime during the year but I don't know about all. Verify for your particular plan.
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

Here is the email I received from FEP BCBS:

“we’re introducing the FEP Medicare Prescription Drug Program (MPDP) in 2024, a prescription drug benefit exclusively for members with Medicare. It’s part of your Blue Cross and Blue Shield Service Benefit Plan coverage.

You’re eligible for MPDP if you:
• Are an FEP member
• Are enrolled in Medicare Part A and/or Part B
• Live in the U.S. or a U.S. territory

With MPDP, you:
• Continue to receive the same FEP health plan benefits you’re used to
• Have more approved prescription drugs than your current benefit
• Get lower out-of-pocket costs for higher-cost drugs
• Have a cap on the amount you pay out-of-pocket on prescriptions annually
Don’t pay any additional premium for your prescription drug coverage

What you need to know:
• If you want MPDP, you don't need to do anything if you have Medicare Part A and Part B. You’ll receive a letter this fall advising that you will be automatically enrolled. If we need any additional information, we'll let you know.
• If you don't want to be automatically enrolled, you can opt out and keep your current FEP prescription drug benefits. The automatic enrollment letter will provide instructions on how to opt out.
• If you miss the opt-out deadline in the letter, you can still let us know that you don’t want MPDP.

If you have questions about MPDP, call 1-888-338-7737 (TTY: 711).”
UpperNwGuy
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by UpperNwGuy »

Richard8655 wrote: Sun Oct 08, 2023 2:21 pm I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
Will prescription costs be handled the same way as other medical costs? In other words, will FEHB pick up the balance after Medicare pays their share?
Richard8655
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Richard8655 »

UpperNwGuy wrote: Tue Oct 17, 2023 8:13 am
Will prescription costs be handled the same way as other medical costs? In other words, will FEHB pick up the balance after Medicare pays their share?
Good point and it seems it should work that way. But it looks like for BCBS (Basic), there still will be copays for all tiers although a bit lower. Also, specialty drugs (including Tier 5) will be moved to the lower copay Tier 4. So all in all, it's starting to look like the new plan is moderately more beneficial.
Last edited by Richard8655 on Tue Oct 17, 2023 11:18 am, edited 1 time in total.
Swansea
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Swansea »

HueyLD wrote: Tue Oct 17, 2023 6:14 am Here is the email I received from FEP BCBS:

“we’re introducing the FEP Medicare Prescription Drug Program (MPDP) in 2024, a prescription drug benefit exclusively for members with Medicare. It’s part of your Blue Cross and Blue Shield Service Benefit Plan coverage.

You’re eligible for MPDP if you:
• Are an FEP member
• Are enrolled in Medicare Part A and/or Part B
• Live in the U.S. or a U.S. territory

With MPDP, you:
• Continue to receive the same FEP health plan benefits you’re used to
• Have more approved prescription drugs than your current benefit
• Get lower out-of-pocket costs for higher-cost drugs
• Have a cap on the amount you pay out-of-pocket on prescriptions annually
Don’t pay any additional premium for your prescription drug coverage

What you need to know:
• If you want MPDP, you don't need to do anything if you have Medicare Part A and Part B. You’ll receive a letter this fall advising that you will be automatically enrolled. If we need any additional information, we'll let you know.
• If you don't want to be automatically enrolled, you can opt out and keep your current FEP prescription drug benefits. The automatic enrollment letter will provide instructions on how to opt out.
• If you miss the opt-out deadline in the letter, you can still let us know that you don’t want MPDP.

If you have questions about MPDP, call 1-888-338-7737 (TTY: 711).”
If I am reading this properly, looks like will not get letter to opt out as I don't have Medicare B. Hopefully I will not be defaulted in.
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

UpperNwGuy wrote: Tue Oct 17, 2023 8:13 am
Richard8655 wrote: Sun Oct 08, 2023 2:21 pm I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
Will prescription costs be handled the same way as other medical costs? In other words, will FEHB pick up the balance after Medicare pays their share?
I asked this of a rep at one FEHB plan. I was told no, BUT, in Section 9 of various FEHB brochures there is a subsection on if a person has Part D how the FEHB plan will "consider" picking up some of the cost. I think this might vary by plans, depending on the initial coverage through the Part D plan as opposed to the FEHB plan Rx coverage. So perhaps the answer is that in some cases some of the balance might be covered. Maybe, some, sometimes. Vague, I know! Good thing to verify with the specific plan.
1grl1by
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by 1grl1by »

I'm very nervous about this. I received the letter from NALC and do not understand what the benefit is or why they are doing this. I'm currently taking 3 different Tier 4 drugs and am very afraid that I will lose out and need to pay literally $300K to continue. I'm not on Medicare yet, will turn 65 in October of '24. I called NALC and the person I spoke to didn't know what I was talking about or what changes there will be for '24. Also, there are major differences in the "summary of benefits" for 2024 on the website and the 2024 booklet.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

1grl1by wrote: Tue Oct 17, 2023 1:19 pm I'm very nervous about this. I received the letter from NALC and do not understand what the benefit is or why they are doing this. I'm currently taking 3 different Tier 4 drugs and am very afraid that I will lose out and need to pay literally $300K to continue. I'm not on Medicare yet, will turn 65 in October of '24. I called NALC and the person I spoke to didn't know what I was talking about or what changes there will be for '24. Also, there are major differences in the "summary of benefits" for 2024 on the website and the 2024 booklet.
Are you on NALC High? Since you are not on Medicare yet you should have time to see how this unfolds, but the brochure states that the coverage and costs are supposed to be the same or better as under the regular plan. See Section 5f (Prescriptions High Option).

This would seem to indicate that the same $3100 per year out of pocket max (for Self Only) for Rx applies as it does for the regular plan Rx. This is a crucial question to ask the rep.

Also, one perk mentioned is a $600 Self Only or $1200 Self+One reimbursement fund given if in the Part D plan.

What major differences did you see in the summary and brochure?

Again, since you are not on Medicare yet you should have time to see how this goes this year and then decide which option is best for your situation.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

Swansea wrote: Tue Oct 17, 2023 10:20 am
HueyLD wrote: Tue Oct 17, 2023 6:14 am Here is the email I received from FEP BCBS:

“we’re introducing the FEP Medicare Prescription Drug Program (MPDP) in 2024, a prescription drug benefit exclusively for members with Medicare. It’s part of your Blue Cross and Blue Shield Service Benefit Plan coverage.

You’re eligible for MPDP if you:
• Are an FEP member
• Are enrolled in Medicare Part A and/or Part B
• Live in the U.S. or a U.S. territory

With MPDP, you:
• Continue to receive the same FEP health plan benefits you’re used to
• Have more approved prescription drugs than your current benefit
• Get lower out-of-pocket costs for higher-cost drugs
• Have a cap on the amount you pay out-of-pocket on prescriptions annually
Don’t pay any additional premium for your prescription drug coverage

What you need to know:
• If you want MPDP, you don't need to do anything if you have Medicare Part A and Part B. You’ll receive a letter this fall advising that you will be automatically enrolled. If we need any additional information, we'll let you know.
• If you don't want to be automatically enrolled, you can opt out and keep your current FEP prescription drug benefits. The automatic enrollment letter will provide instructions on how to opt out.
• If you miss the opt-out deadline in the letter, you can still let us know that you don’t want MPDP.

If you have questions about MPDP, call 1-888-338-7737 (TTY: 711).”
If I am reading this properly, looks like will not get letter to opt out as I don't have Medicare B. Hopefully I will not be defaulted in.
Verify this with your insurance. I have seen at least one of these plans which stated if one is on Part A only, or Part B only, or Parts A and B both then one would be automatically enrolled. I would verify more than once as this is new to the reps too!!!
Naismith
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Naismith »

I wondered if this was to allow FEHB to take part in the recently announced Medicare price negotiations for drugs.

When I heard that Medicare would be negotiating for better prices, I remember thinking, "That's nice, but doesn't apply to BCBS..."

Maybe now it will.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

Richard8655 wrote: Tue Oct 17, 2023 9:43 am
UpperNwGuy wrote: Tue Oct 17, 2023 8:13 am
Will prescription costs be handled the same way as other medical costs? In other words, will FEHB pick up the balance after Medicare pays their share?
Good point and it seems it should work that way. But it looks like for BCBS (Basic), there still will be copays for all tiers although a bit lower. Also, specialty drugs (including Tier 5) will be moved to the lower copay Tier 4. So all in all, it's starting to look like the new plan is moderately more beneficial.
The BCBS site now states that beginning 10/28/23 the prescription cost calculator will also include the new Part D Rx costs for all of their plans, so that should make it easier to see which option will work for one's situation.
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

UPDATE--Please see my post over at the thread FEHB With Medicare--It's In The Details about updated info about possible IRMAA related additional premium for some of the new Part D Rx options rolling out. Very Important!!

viewtopic.php?t=361626&start=50


Link added as suggested.
Last edited by tallguy3891 on Sat Oct 21, 2023 10:16 am, edited 3 times in total.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

tallguy3891 wrote: Wed Oct 18, 2023 4:39 pm UPDATE--Please see my post over at the thread FEHB With Medicare--It's In The Details about updated info about possible IRMAA related additional premium for some of the new Part D Rx options rolling out. Very Important!!
You could link it here so people don't have to go hunt for it
Midwater
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Midwater »

No letter yet in the mail. I just read about the new FEP Medicare Prescription Drug Program.  FEP members with Medicare Part A and/or Part B will be eligible to enroll in a new Medicare Part D drug plan that offers additional approved prescription drugs in some tiers and lower out-of-pocket costs for high-cost drugs, with no separate premium. This sounded good when I read about it, however, what about the drug manufacture co-pay programs that offer free or discounted priced name brand medications. They offer the co-pay programs to people that have Commercial prescription drug insurance through an employer-sponsored or private health plan or the Federal Employee Health Benefit Plan. However, if you have Prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs, you are NOT eligible for these drug manufacture co-pay programs. The new FEP Medicare Prescription Drug Program automatically enrolls FEP members in this new Medicare Part D drug plan program. If you don't want to be automatically enrolled, you must call your FEP plan and request to opt out and keep your current FEP prescription drug benefits.

Currently I use four brand name medications and use the manufacture co-pay programs. These medications cost me $300/year. If I went through my FEP BCBS medical insurance, these same four medications would cost me $2,239/year. With the new FEP Medicare Prescription Drug Program that automatically enrolls me in the Medicare Part D drug plan, I would not be eligible for the drug manufacture co-pay programs and would have to pay $2,239/year for my medications. I am curious about this new FEP Medicare Part D Prescription Drug Program and how it affects the drug manufacture co-pay programs?

I do know that NARFE is having a BlueCross BlueShield’s FEP Medicare Prescription Drug Program seminar on Tuesday, October 24, 2023, from 2 to 4 p.m. I have signed up for this seminar and hope to get answers to my questions there too.
stan1
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by stan1 »

Midwater wrote: Sat Oct 21, 2023 1:23 pm Currently I use four brand name medications and use the manufacture co-pay programs.
Which plan are you on now? I have BCBS Standard, when I called their contracted mail order pharmacy, Caremark, I was told they would not accept co-pay coupons several different times. BCBS Basic does not offer a mail order pharmacy to those under 65.
Midwater
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Midwater »

I have BCBS Standard. The manufacture co-pay programs can only be used at your local pharmacy (I use CVS) or specialty medication pharmacy (I use Dana Farber Cancer Specialty Pharmacy). CVS Caremark doesn't accept the co-pay program cards.
stan1
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by stan1 »

Midwater wrote: Sat Oct 21, 2023 5:19 pm I have BCBS Standard. The manufacture co-pay programs can only be used at your local pharmacy (I use CVS) or specialty medication pharmacy (I use Dana Farber Cancer Specialty Pharmacy). CVS Caremark doesn't accept the co-pay program cards.
Thank you for confirming, it doesn't make sense but I guess Caremark mail order doesn't want to deal with it and BCBS isn't telling them they have to.
slackjawedprimate
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by slackjawedprimate »

HoneyBee's comments say it all. I too am suspicious of this apparently minor change. Why an opt-out notice?
bsteiner
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by bsteiner »

tallguy3891 wrote: Wed Oct 18, 2023 4:39 pm UPDATE--Please see my post over at the thread FEHB With Medicare--It's In The Details about updated info about possible IRMAA related additional premium for some of the new Part D Rx options rolling out. Very Important!!

viewtopic.php?t=361626&start=50


Link added as suggested.
That's my concern. My wife is a retired Federal employee and we have FEHB (MHBP). But it's secondary for us since I'm still working so my employer's plan is primary. If we opt out of the new D to avoid the IRMAA charges, can we opt back in after I retire if we're willing to pay the IRMAA charges to get the $2,000 per person annual cap on drug co-pays?
bsteiner
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by bsteiner »

And if you switch to D, can you switch back later?
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

bsteiner wrote: Mon Oct 30, 2023 10:08 am And if you switch to D, can you switch back later?
Yes.

Did you receive a letter from the insurance company? The letter I received from FEPBlue says so.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

bsteiner wrote: Mon Oct 30, 2023 10:08 am And if you switch to D, can you switch back later?

I don't think anyone knows. These are brand new.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

HueyLD wrote: Mon Oct 30, 2023 10:12 am
bsteiner wrote: Mon Oct 30, 2023 10:08 am And if you switch to D, can you switch back later?
Yes.

Did you receive a letter from the insurance company? The letter I received from FEPBlue says so.
Everything I have seen states one can opt OUT at any time and revert to the "regular" plan Rx the first of the following month. However, everything I have seen states one can only opt IN during Open Enrollment. It is possible they would allow enrollment upon becoming eligible for Medicare if outside Open Season? I think it is best to check carefully the brochure for your plan, Section 5 on Prescriptions, and Section 9 on Medicare, and also with a rep at the company.
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

tallguy3891 wrote: Mon Oct 30, 2023 11:35 am
HueyLD wrote: Mon Oct 30, 2023 10:12 am
bsteiner wrote: Mon Oct 30, 2023 10:08 am And if you switch to D, can you switch back later?
Yes.

Did you receive a letter from the insurance company? The letter I received from FEPBlue says so.
Everything I have seen states one can opt OUT at any time and revert to the "regular" plan Rx the first of the following month. However, everything I have seen states one can only opt IN during Open Enrollment. It is possible they would allow enrollment upon becoming eligible for Medicare if outside Open Season? I think it is best to check carefully the brochure for your plan, Section 5 on Prescriptions, and Section 9 on Medicare, and also with a rep at the company.
My understanding is the same as yours.

And for someone new to Medicare, (s)he has to be eligible to enroll in MPDP even outside Open Season. Anything else would not be logical.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

HueyLD wrote: Mon Oct 30, 2023 12:03 pm
tallguy3891 wrote: Mon Oct 30, 2023 11:35 am
HueyLD wrote: Mon Oct 30, 2023 10:12 am
bsteiner wrote: Mon Oct 30, 2023 10:08 am And if you switch to D, can you switch back later?
Yes.

Did you receive a letter from the insurance company? The letter I received from FEPBlue says so.
Everything I have seen states one can opt OUT at any time and revert to the "regular" plan Rx the first of the following month. However, everything I have seen states one can only opt IN during Open Enrollment. It is possible they would allow enrollment upon becoming eligible for Medicare if outside Open Season? I think it is best to check carefully the brochure for your plan, Section 5 on Prescriptions, and Section 9 on Medicare, and also with a rep at the company.
My understanding is the same as yours.

And for someone new to Medicare, (s)he has to be eligible to enroll in MPDP even outside Open Season. Anything else would not be logical.
Being eligible for Medicare is not a qualifying life event to change your fehb plan, so there is precedence in it "not being logical".
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

tj wrote: Mon Oct 30, 2023 12:34 pm
HueyLD wrote: Mon Oct 30, 2023 12:03 pm
tallguy3891 wrote: Mon Oct 30, 2023 11:35 am
HueyLD wrote: Mon Oct 30, 2023 10:12 am
bsteiner wrote: Mon Oct 30, 2023 10:08 am And if you switch to D, can you switch back later?
Yes.

Did you receive a letter from the insurance company? The letter I received from FEPBlue says so.
Everything I have seen states one can opt OUT at any time and revert to the "regular" plan Rx the first of the following month. However, everything I have seen states one can only opt IN during Open Enrollment. It is possible they would allow enrollment upon becoming eligible for Medicare if outside Open Season? I think it is best to check carefully the brochure for your plan, Section 5 on Prescriptions, and Section 9 on Medicare, and also with a rep at the company.
My understanding is the same as yours.

And for someone new to Medicare, (s)he has to be eligible to enroll in MPDP even outside Open Season. Anything else would not be logical.
Being eligible for Medicare is not a qualifying life event to change your fehb plan, so there is precedence in it "not being logical".
Becoming eligible for Medicare is a Qualifying Life Event, as are some other things:

https://www.medicare.gov/basics/get-sta ... nt-periods


https://www.opm.gov/healthcare-insuranc ... urning-65/

https://www.opm.gov/forms/pdf_fill/opm2809.pdf

Note in particular 2L on form OPM 2809 (not SF-2809).
Last edited by tallguy3891 on Mon Oct 30, 2023 1:34 pm, edited 1 time in total.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

tallguy3891 wrote: Mon Oct 30, 2023 1:32 pm
tj wrote: Mon Oct 30, 2023 12:34 pm
HueyLD wrote: Mon Oct 30, 2023 12:03 pm
tallguy3891 wrote: Mon Oct 30, 2023 11:35 am
HueyLD wrote: Mon Oct 30, 2023 10:12 am
Yes.

Did you receive a letter from the insurance company? The letter I received from FEPBlue says so.
Everything I have seen states one can opt OUT at any time and revert to the "regular" plan Rx the first of the following month. However, everything I have seen states one can only opt IN during Open Enrollment. It is possible they would allow enrollment upon becoming eligible for Medicare if outside Open Season? I think it is best to check carefully the brochure for your plan, Section 5 on Prescriptions, and Section 9 on Medicare, and also with a rep at the company.
My understanding is the same as yours.

And for someone new to Medicare, (s)he has to be eligible to enroll in MPDP even outside Open Season. Anything else would not be logical.
Being eligible for Medicare is not a qualifying life event to change your fehb plan, so there is precedence in it "not being logical".
Becoming eligible for Medicare is a Qualifying Life Event, as are some other things:

https://www.medicare.gov/basics/get-sta ... nt-periods


https://www.opm.gov/healthcare-insuranc ... urning-65/

https://www.opm.gov/forms/pdf_fill/opm2809.pdf
Oh. Maybe it's retiring from federal service that isn't a QLE.
bklown3
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by bklown3 »

The info is a little hard to fully compare on BCBS Standard.

For me, it looks like the wife and I would BOTH have to pay the IRMAA on Part D so that would be an added expense so I am opting out for now.
Mals
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Mals »

Yes, you would both have to pay the IRMAA for Part D every month. Also, the out of pocket cap that they are touting for this plan is part of the Inflation Reduction Act and is REQUIRED FOR ALL PART D PLANS.
Everyone's situation is different and it is very difficult to compare the new plan with the plan we currently have. My wife and I have chosen to opt out for now.
NI HAU MA
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by NI HAU MA »

FEP Medicare Prescription Drug Program

I received my letter from BC/BS FEP yesterday and on the first page one of the bullet points states:

"You don't pay a separate premium - it's included in your FEP premium.*"

The footnote referenced by the above sentence reads:

"*Depending on your income you may need to pay an Income Related Monthly Adjustment Amount (IRMAA). Learn more at medicare.gov. Most members will not meet the threshold to qualify for IRMAA."

As if you'd want to "qualify" for IRMAA.
Swansea
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Swansea »

I was supposed to receive my letter yesterday, did not come, nor today. Called to opt out, put on hold 50 minutes. Agent entered my ID number multiple times, but could not find me in the system...great. Back to square one.
bartmart
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by bartmart »

Richard8655 wrote: Sun Oct 08, 2023 2:21 pm I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
Good point - I can see the advantage of taking part b - potentially a 10 percent surcharge penalty for each year you refuse to take it! However, there will be no penalty for refusing to take FEP Medicare Part D if covered by FEHB. I am going to Opt Out for the time being and let OPM continue to manage it.
Richard8655
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Richard8655 »

bartmart wrote: Wed Nov 01, 2023 9:18 am
Richard8655 wrote: Sun Oct 08, 2023 2:21 pm I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
Good point - I can see the advantage of taking part b - potentially a 10 percent surcharge penalty for each year you refuse to take it! However, there will be no penalty for refusing to take FEP Medicare Part D if covered by FEHB. I am going to Opt Out for the time being and let OPM continue to manage it.
That's a good strategy too. Opt out of the Part D program and see how it goes. One can always join in the future. But I completely agree that Part B should be taken immediately if desired (as I did after much churning) rather than later to avoid the annual 10% penalty. But with Part D I'll go the other way and try it next year, and opt out the following year if not working out as expected.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

Richard8655 wrote: Wed Nov 01, 2023 9:58 am
bartmart wrote: Wed Nov 01, 2023 9:18 am
Richard8655 wrote: Sun Oct 08, 2023 2:21 pm I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
Good point - I can see the advantage of taking part b - potentially a 10 percent surcharge penalty for each year you refuse to take it! However, there will be no penalty for refusing to take FEP Medicare Part D if covered by FEHB. I am going to Opt Out for the time being and let OPM continue to manage it.
That's a good strategy too. Opt out of the Part D program and see how it goes. One can always join in the future. But I completely agree that Part B should be taken immediately if desired (as I did after much churning) rather than later to avoid the annual 10% penalty. But with Part D I'll go the other way and try it next year, and opt out the following year if not working out as expected.
All of the FEHB Part D plans I have looked at state one can opt OUT at any time and the "regular" plan Rx resumes the first of the next month. Apparently not a requirement to wait for Open Season to opt out. If one initially opts out or opts out during the year, one can only opt back IN at the next Open Season. Verify with your particular plan.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

tallguy3891 wrote: Wed Nov 01, 2023 10:21 am
Richard8655 wrote: Wed Nov 01, 2023 9:58 am
bartmart wrote: Wed Nov 01, 2023 9:18 am
Richard8655 wrote: Sun Oct 08, 2023 2:21 pm I don't see Tier 5 drugs covered under the new MPDP plan (in the comparison view with Basic), as they already are under the regular FEPBLUE pharmacy benefit. Unless I missed something in how the new plan is being organized. But on second reading, look like Tier 5 is being merged into Tier 4.

Frankly, I think FEPBLUE is offloading drug expenses onto the government (Medicare) as they do with pressuring participants to take Part B.
Good point - I can see the advantage of taking part b - potentially a 10 percent surcharge penalty for each year you refuse to take it! However, there will be no penalty for refusing to take FEP Medicare Part D if covered by FEHB. I am going to Opt Out for the time being and let OPM continue to manage it.
That's a good strategy too. Opt out of the Part D program and see how it goes. One can always join in the future. But I completely agree that Part B should be taken immediately if desired (as I did after much churning) rather than later to avoid the annual 10% penalty. But with Part D I'll go the other way and try it next year, and opt out the following year if not working out as expected.
All of the FEHB Part D plans I have looked at state one can opt OUT at any time and the "regular" plan Rx resumes the first of the next month. Apparently not a requirement to wait for Open Season to opt out. If one initially opts out or opts out during the year, one can only opt back IN at the next Open Season. Verify with your particular plan.
In AFSPA 's email today for the fsbp, they mentioned it's not a requirement to enroll in part a or part b to enroll in the fehb part d
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