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Re: [TSPStrategy] TSP PP contribution in 2024

Re: [TSPStrategy] TSP PP contribution in 2024

In some ways, it doesn't really matter if you start earlier than the first pay period of 2024.  If you have reached the limit of contributions in 2023, the TSP will just limit the excess deposit to the maximum.  Then for 2024, you'll be set up with $1174 per pp through all of 2024, and the last pay period they will limit your attempt to deposit anything more than the $30,500. as you might have tried to deposit over the limit by about about $20.
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[TSPStrategy] TSP PP contribution in 2024

[TSPStrategy] TSP PP contribution in 2024

I want to max my per pp contribution in 2024. I'm over 55, and get payed via NFC. I figure that's $30,500 / 26 pp = $1173 (or should it be $1174 per pp?). But I can never figure out how to read pp calendars. Which pp is the first pp to pay in 2023, where I make the amount change?

Thanks in advance.

btw, happy to be 100% C
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[TSPStrategy] TSP board OKs new international fund index, this time without China

[TSPStrategy] TSP board OKs new international fund index, this time without China

https://www.govexec.com/pay-benefits/2023/11/tsp-board-oks-new-international-fund-index-time-without-china/392049/

TSP board OKs new international fund index, this time without China

A previous effort to move the I Fund to a broader benchmark index, which included investments in Chinese corporations, met opposition from the Trump administration and Republican lawmakers.

The agency responsible for administering the federal government's 401(k)-style retirement savings program announced Tuesday that next year, the Thrift Savings Plan will transition its portfolio of international investments to a new, broader index, which officials say will improve the I Fund's performance.

The TSP's core funds all track a benchmark index that guide investment in a market sector, be that small or large businesses in the cases of the S and C funds, respectively, or investments in international markets, as is the case with the I Fund. For years, the I Fund has been tied to the MSCI Europe, Australasia and Far East Index.

But next year, the TSP will move I Fund investments to a new, broader, index in the form of the MSCI All Country World ex USA ex China ex Hong Kong Investable Market Index, or MSCI ACWI IMI ex USA ex China ex Hong Kong Index, for slightly shorter.

Diversifying federal employees and retirees' international investments has been a priority for the TSP for years. In 2017, the Federal Retirement Thrift Investment Board, which administers the TSP, voted to change the I Fund's index to the MSCI All Country World Ex-US Investable Market Index with a plan to make the transition occur in 2020.

But that effort was derailed by a flurry of last-minute pressure by Republican lawmakers, who argued that federal employees and military service members' retirement accounts should not be invested in Chinese corporations. The Trump administration ultimately ordered TSP officials to cease efforts to implement the index transition, culminating in the FRTIB indefinitely postponing the move and its chairman resigning amid cries of political interference in an agency with a solely fiduciary responsibility to TSP participants.

The newly selected benchmark index notably excludes all investments in both China and Hong Kong, but the reasoning behind the choice isn't political, officials said. According to Aon, a consulting firm that advised TSP officials on the matter, conditions have changed increasing the risk profile of Chinese securities.

"Overall, operational complexity has increased when investing in emerging markets in recent years given a range of events such as investment restrictions on sensitive Chinese technology sectors, delisting of Chinese companies and sanctions on Russian securities due to the Russia-Ukraine conflict," Aon wrote. "These types of events can incur transaction costs and may cause performance and volatility swings. Given the asset size of the I Fund, the forced selling of restricted investments could incur higher than average market impact costs due to liquidity challenges. If the current investment restrictions on China are the beginning of further restrictions spanning China and Hong Kong investments, this level of uncertainty can outweigh the benefits of expanding the I Fund to include China and retaining exposure to Hong Kong, based on the TSP's specific circumstances."

The TSP's current I Fund index exposes participants to nearly 800 stocks across 21 developed markets, representing 55% of international market capitalization. The MSCI ACWI IMI ex USA ex China ex Hong Kong Index increases that exposure to 5,621 stocks in 21 developed markets and 23 emerging markets, and represents 90% of non-U.S. market capitalization, and is expected to outperform the existing index on a long-term basis.

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[TSPStrategy] An Open Season checklist for active federal employees

[TSPStrategy] An Open Season checklist for active federal employees

https://www.govexec.com/pay-benefits/2023/11/open-season-checklist-active-federal-employees/391884/

An Open Season checklist for active federal employees

Tips for saving money on health care and to help guide you through the process of choosing a plan in the Federal Employees Health Benefits Program.

Next year, federal employees will face higher health plan premiums, fewer choices, and big benefit changes. As FEHB Open Season starts, here's a checklist to guide you through the process of choosing a plan, plus tips on how to save money on health care costs.

Confirm Available Plans

First, find out which plans you can enroll in. There are 156 FEHB plans available in 2024, far fewer than the 271 in 2023. The main reason for the drop is Humana's departure from FEHB, but NALC Value, Indiana University Health Plan, and AultCare also won't be available next year. 

HMO service area changes could also alter plan availability. Counties can be added or subtracted from a plan service area from year to year. For example, Kaiser plans in Colorado have significant service area changes as they have both added and subtracted counties.

There aren't very many new plans next year. Compass Rose now has two options, high and standard, and they've also added a new agency with enrollment eligibility for those plans, the Veterans Affairs Department. Sentara Health has added a plan in Northern Virginia. 

Review Section 2 of the FEHB Plan Brochure

The official plan brochure is an invaluable source of information on how your FEHB plan works. However, each brochure often has more than 100 pages, which can be overwhelming. The one thing you should check every Open Season is section 2, "Changes for 2024." Here, the plan will alert you to important benefit changes like a cost share increase for a service, new preauthorization requirements, or new benefits for the upcoming year. Plan brochures can be found on the plan website, OPM plan comparison tool, and Checkbook's Guide to Health Plans.

Here are examples of some 2024 changes:

  • MetLife dental and vision plans will offer complimentary identity and fraud protection
  • SAMBA plans have added doula coverage
  • BCBS plans have added family and marital counseling
  • APWU is switching provider networks from CIGNA to UnitedHealthcare
  • UnitedHealthcare Choice Plus Advanced is doubling the catastrophic maximum from $3,000 to $6,000 for self-only enrollees and from $6,000 to $12,000 for self-plus-one and self & family enrollees

Importantly, 2024 will see improved fertility benefits for federal employees. All FEHB plans must now cover artificial insemination procedures and fertility drugs associated with AI and IVF procedures. Section 2 will notify you of these changes, and you should also carefully read the reproductive services part of the plan brochure found in section 5(a). 

One national PPO plan with open enrollment, BCBS Standard, has added a significant new benefit for 2024—a $25,000 annual maximum for assisted reproductive technologies which includes IVF. Covered AI procedures and fertility drugs do not count toward the $25,000 maximum. Keep in mind you'll still pay 15% for ART services when using preferred providers, and BCBS Standard has the highest premiums of any national PPO plan. 

Use Yearly Cost Estimates to Narrow Down Plans

While important, and a for-sure expense, selecting an FEHB plan on premium alone ignores what you'll pay when using covered services and the impact of a plan contributing to a health savings or reimbursement account.

For 45 years Checkbook's Guide to Health Plans for Federal Employees has ranked plans on estimated total cost based on user information—age, family size, and expected healthcare usage. The benchmark ranking shows big price differences among plans.

For example, a family of four in the Washington, D.C., area with age 50 primary insured and average healthcare expenses could save $4,590 in estimated costs switching from BCBS Standard to NALC CDHP.

Check Providers and Prescription Drugs

These are the last two steps before enrolling in your FEHB plan, and they impact both the cost and care you'll receive. If you have existing providers, you'll want to check how they're covered by the plan. You always pay less by staying in-network, and you can't assume the providers will remain unchanged from one year to the next. You can find a provider directory on the plan website.

Similarly, for any current medications you take, you'll want to check to see if they're covered. Many FEHB plan websites will have prescription drug cost tools where you'll be able to select your drug, dosage, and preferred pharmacy. Again, you can't assume there won't be any prescription drug changes in your current plan from one plan year to the next.

Take Advantage of Tax Preferred Savings Accounts

With a 7.7% increase in the average enrollee share of FEHB premiums for 2024, federal employees should be looking for ways to save money on healthcare expenses. 

Only about 20% of federal employees use a flexible spending account, but that number should be 100% as all federal employees will have some predictable healthcare expenses—dental care, vision care, planned medical visits, prescription drug refills, or over-the-counter pharmacy items. Through funding from payroll contributions before taxes, paying for approved healthcare expenses with the FSA will save you about 30%. 

Employees can contribute up to $3,050, but you must be somewhat careful in budgeting as only $610 of unused funds can be rolled over into a new plan year. Employees with an HSA aren't allowed to have a healthcare FSA, but they can still set up a limited expense FSA for dental and vision expenses, which is a good idea to help keep HSA funds invested. You must renew your enrollment every Open Season to keep your FSA. You can enroll and learn more at FSAFEDS.

HSAs offered by high deductible plans offer federal employees an even greater opportunity to save for both immediate and future healthcare expenses. HSA contribution limits are increasing in 2024 to $4,150 for self-only enrollees and $8,300 for self-plus-one and self & family enrollments. HDHPs fund the HSA with a monthly premium pass-through that varies by plan and ranges between $750 to $1,200 for self-only enrollees and $1,500 for $2,400 for self-plus-one and self & family enrollments. Voluntary contributions are triple tax advantaged—they go in tax-free, grow tax-free, and if withdrawn for a qualified healthcare expense, exit tax-free. Once you turn 65, you can make non-medical distributions from the HSA and only pay your normal tax obligations. 

FSA and HSA eligibility ends once you retire and have Medicare. 

The Final Word

Only about 5% of federal employees switch health plans every year. If you've kept the same one for many years, now is the time to see if there might be a plan that offers better value with equal or better coverage.

Following this Open Season checklist will point you in the right direction:

  • Understand what plans are available to you 
  • Check section 2 of the FEHB plan brochure to stay up-to-date of important plan benefit changes 
  • Use yearly cost estimates to find plans that offer the best value
  • Research your providers and prescription drugs before enrolling in a plan

Also, don't forget to take advantage of tax-preferred savings accounts to save money next year. Both the FSA and HSA can provide substantial savings on health care expenses.

Kevin Moss is a senior editor with Consumers' Checkbook. Checkbook's 2024 Guide to Health Plans for Federal Employees is available now. Check here to see if your agency provides free access. The Guide is also available for purchase and Government Executive readers can save 20% by entering promo code GOVEXEC at checkout.

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[TSPStrategy] Answers to some of your common questions about CSRS and FERS

[TSPStrategy] Answers to some of your common questions about CSRS and FERS

https://www.govexec.com/pay-benefits/2023/11/some-your-common-questions-answered-about-csrs-and-fers/391907/

Answers to some of your common questions about CSRS and FERS

Federal retirement expert Tammy Flanagan says "the devil is in the details."

Federal employees and retirees have so many questions regarding retirement, and it is always a situation where the "devil is in the details!"  Let's look at a few of the very common questions that come up when planning for retirement under CSRS and FERS:

Question: Should I stay on the payroll and use up my annual leave balance before I retire, or should I take the lump sum payment?

Answer: Which is the right choice? Taking the lump sum. The simple reason is that you're not supposed to take leave when you are on your way out the door. The comptroller general has ruled that federal managers cannot grant an employee "terminal leave" if they know in advance that the employee is going to separate from federal service when the leave is used up. However, there are always ways around this by using the leave throughout the year, so it is worth looking at this question another way by trying to figure out if you would come out better financially by taking the lump sum or expiring out the balance prior to retirement? That's a more interesting, and more complicated, question.

Here is an example to consider

This employee plans to retire under the Civil Service Retirement System next year. Her plan was to take her annual leave (at least 240 hours carried over from 2023), extending her date to retire rather than leaving earlier and getting a lump sum payout, but she is looking at both options.

Option 1: Take the lump-sum payment. Receive a lump sum payment for 240 hours of leave (or more). Let's assume that her hourly pay rate (which is her annual pay rate divided by 2,087) is $59.07. The payment for 240 hours of unused annual leave would be $14,176.80, minus taxes. Of course, she will earn additional leave by continuing to work in 2024.

Option 2: Retire when the annual leave is used up. That way, she'll receive four more pay periods (240 hours) worth of full salary instead of retired pay, and her retirement benefit will reflect two more months of service since she extended her service by the amount of annual leave.

So far, it looks like using the leave and staying on the payroll makes sense. The employee figured her additional salary for staying on the payroll longer would be $18,902 before deductions (these include retirement contributions, insurance premiums and taxes). Taxes are withheld from the annual leave payment, but not retirement deductions or insurance premiums. She calculated that she would come out with about $5,000 extra in her pocket by staying the extra two months and receiving her full salary longer. Also, her retirement benefit would increase by $32 per month for the rest of her life with the additional two months of service. 

There is something else to consider, however. If she retires and gets a lump-sum payment for unused annual leave, she can then receive a retirement check for an additional two months. Since she is retiring under CSRS, her monthly annuity payment was computed at $6,485 before taxes and insurance withholdings. That's a lot of money just for waking up every day.  Under this scenario, she would end up with around $8,000 in cash by retiring and taking the lump sum payout. Considering that if she stayed on the job two more months and her retirement goes up only $32 a month, it would take her more than 20 years to break even ($8,000 / $32 = 250 months / 12 = 20.8 years).

But if you're covered under FERS, it's a different story. By staying longer on the payroll and using the annual leave, you can continue to contribute to your Thrift Savings Plan and Social Security, as well as your retirement benefit. Plus, you would receive your full salary longer. The basic FERS retirement benefit would be only about half as much as it would be under CSRS. Under FERS, the computation generally is 1% (or 1.1%if retiring at age 62 or later with 20 or more years of service) times the high-three average salary times years and months of service. Under CSRS, after 10 years of service, all years are worth 2% times the high-three average salary. But the additional matching and automatic TSP contributions for four more pay periods would be almost $1,000 for this employee, plus the same amount in employee contributions -- or more (assuming TSP contributions are 5% of salary or greater).

The bottom line is that regardless of the financial advantages or disadvantages of using the leave while employed, it might be nice to have the lump-sum annual leave payment to weather the transition from employee to annuitant. It can take several months before your retirement benefits are finalized. It is nice to have a little cash cushion to tide you over during this period.

Question:  My husband died at 50 (in 2018). I have not claimed a survivor's benefit other than for our daughter who is now 21 and received benefits until she was out of high school.  I am now trying to decide if I should claim my widow's benefit at age 60 or wait until I'm 62 to claim my own Social Security retirement.

Answer: I'm sorry that you became a widow so young. Because your daughter was already over 16 when her dad died, you weren't entitled to receive any benefits when you lost your husband (parents can collect when the child is under 16).

This is a complicated question, and the answer is, "it depends."  Here are the factors that would help determine the best action:

·       Are you working? If you are, there is an earnings limit that would potentially reduce or even eliminate your ability to receive widow's and / or Social Security retirement benefits. For 2024, if you earn more than $1,860 / month ($22,320 / year), you will have her benefit reduced by $1 for every $2 earned over this limit). If you are not working, but return to work, be sure to notify Social Security to avoid being overpaid. 

·       How much is your late husband's benefit amount compared to your own earned benefit? In cases where your husband's benefit was substantially greater than your own benefit, it might make sense to draw your own benefit first and delay the widow's benefit until you reach your full retirement age when it won't be subject to an age reduction for filing early. On the other hand, if your own earned benefit is substantial and by delaying your claim to age 70, you will receive a greater benefit than the widow's amount, it could make sense to claim the widow's benefit early (at age 60 or when your earning fall below the limit) and delay your own earned benefit payment. 

·   How much of your total income is coming from SSA (is this your main source of income or do you have substantial income from investments / retirement accounts and your own pension benefit?)

Once all of the pieces of the puzzle are considered, then it can become more clear whether she should apply sooner or later and for whose benefit should take precedence.

In most typical claims for benefits a:

• Widow or widower, at full retirement age or older, generally gets 100% of the worker's basic benefit amount.

• Widow or widower, age 60 or older, but under full retirement age, gets between 71% and 99% of the worker's basic benefit amount.

• Widow or widower, any age, with a child younger than age 16, gets 75% of the worker's benefit amount.

• Child gets 75% of the worker's benefit amount.

Here are some references to help when deciding when to claim Social Security benefits:

Social Security Website: www.ssa.gov

Social Security:  If You Are the Survivor

Survivors Benefits

Smart Social Security Strategies for Women

2024 Social Security Changes

Exempt Amounts Under the Social Security Earnings Test

eBook by Mary Beth Franklin, Maximizing Social Security:  https://marybethfranklin.com/ebook-on-social-security-estimated-benefits/

Question: I'm a retired Federal Law Enforcement Officer who has medical coverage through FEHB (Blue Cross). Amazingly, I'm coming up on my 65th birthday next summer and have spoken to several friends in similar situations and their responses fall into two camps.

A. Take Medicare A and B, drop to a lower Blue Cross coverage plan and all is good.  Except that I'd pay over $400 per month for Medicare coverage due to Income-Related Monthly Adjustment Amounts (IRMAA) which would cost me approximately $5000 per year to enroll in Part B, or

B. Don't take Medicare and let my current coverage stand. No Medicare payment whatsoever.

My question is what would happen if at some point in the future I'm "required" to take Medicare (the current system changes to make all retirees take Medicare) and then get charged the 10% per year late fee for not taking Medicare when I'm first eligible?  I guess I want to have my cake and eat it too, but right now it seems like Medicare may be an unnecessary expense, if the rules don't change and I'm not subject to the penalty down the road. The question may not even be answerable (several people believe this to be true) because there may be too many unknowns, but I'd appreciate any input you could provide.

Answer: You have been told correctly concerning the option to forgo Part B and just use FEHB alone or enroll in Part B (and Part A) and possibly change to BC/BS Basic (or GEHA High Option or Aetna Direct or any FEHB plan that provides incentives to enroll in Medicare A and B). If Congress requires Medicare to continue FEHB in the future, It could happen that they would do the same thing that is happening for postal retirees next year (but that is a completely unknown and "not on the table" option at this time):

According to the National Association of Active and Retired Federal Employees, eligible Postal annuitants and family members not enrolled in Medicare Part B as of Jan. 1, 2024 will be eligible for a six-month, penalty free, Special Enrollment Period (SEP) to enroll in Medicare Part B, beginning April 1, 2024. While the SEP is available to those interested in the option, there is no requirement to enroll in Part B. However, those who do take advantage of this SEP will not have to pay the late enrollment penalty, which increases premiums by 10% for each 12-month period they could have been enrolled in Part B but did not sign up for coverage. Instead, the Postal Service will cover the penalty. Annuitants who decide to enroll will still have to pay the Medicare Part B monthly premium. OPM and the Social Security Administration will determine who is eligible for the SEP and inform those who meet the requirements.

If you decide not to take Part B, you will continue to pay your deductible, copays and coinsurance from age 65 to age 105 (or beyond).  Most likely, you will find that for the first 10 years or so of that period, you will most likely come out ahead if you don't take part B and remain in good health, but no guarantees! In my opinion, paying the IRMAA could be a small price to pay for 100% coverage for the rest of your life on both inpatient as well as outpatient medical care. In addition, if you are still working in your second career, consider your income once you are fully retired. Will you drop to a lower IRMAA bracket? Only 7% of all Medicare beneficiaries are impacted by IRMAA surcharges.

Talk to someone in their 70s, 80s or older and ask them how often they are at the doctor's office and how much they pay out of pocket if they have FEHB and Medicare. Where do you find people like that? Visit your local chapter of NARFE where you will find many retirees older than 65; some are covered by Medicare and some are not! It is estimated that on average 20% to 25% of Medicare eligible retirees choose not to enroll in Medicare Part B, however, 75% to 80% of them do.

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Re: [TSPStrategy] Zweig breadth thrust

Re: [TSPStrategy] Zweig breadth thrust


On Fri, Nov 10, 2023 at 10:42 AM TonyS via groups.io <goody7531=gmail.com@groups.io> wrote:
This is from a few days ago.  What do you think?



Thanks, 

Tony

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[TSPStrategy] Zweig breadth thrust

[TSPStrategy] Zweig breadth thrust

This is from a few days ago.  What do you think?



Thanks, 

Tony
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[TSPStrategy] Medicare Part D is coming to an FEHB plan near you

[TSPStrategy] Medicare Part D is coming to an FEHB plan near you

https://www.govexec.com/pay-benefits/2023/11/medicare-part-d-coming-fehb-plan-near-you/391723/

Medicare Part D is coming to an FEHB plan near you

The prescription drug benefit is being automatically added to many of the FEHB program options for the 2024 plan year.

This week, I want to introduce you to some new acronyms that you may need to understand if you are near age 65 or older and covered by one of the 156 plan choices that will be available in 2024. Open Season 2023 begins on Nov.13 and federal employees as well as retirees, survivor annuitants and eligible former spouses will be analyzing their options for the Federal Employees Health Benefits program and Federal Employees Dental and Vision Insurance Program as well as how much to set aside in a health care or dependent care FSA.  

A new benefit is being automatically added to many of the FEHB program options for the 2024 plan year for retirees who are also enrolled in Medicare Part A and/or Part B: Medicare Part D, the prescription drug benefit under the government's national health insurance program. This benefit has been previously included in the Medicare Advantage options that have been added to many FEHB plans over the past few years and will also be available for some plans without the additional Medicare Advantage benefit. For plan year 2024, plans offering this benefit will automatically coordinate with FEHB through an Employer Group Waiver Plan. EGWPs are offered either as a standalone Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.  

You may find that if your plan is offering this benefit for 2024, they may provide separate brochures detailing these benefits which may have been mailed to you prior to open season. For example, BC/BS has published a brochure titled, "Get to know the FEP Medicare Prescription Drug Program." You can also find information on how your plan coordinates with Medicare on your plan websites. GEHA, like many FEHB plans, has a Medicare and a new Medicare Advantage link on their website where you will find explanations of the options that are available for members who want to add the Medicare Advantage option and for those who have Medicare A and B and prefer not to add the Medicare Advantage enhancement benefit. You can also learn more about how your FEHB plan coordinates with Medicare by checking Section 9 of the 2024 FEHB plan brochure.  

It is not surprising that retirees have questions about these new benefits. Here are some that have come from members of the National Active and Retired Federal Employees Association over the past few weeks:

Q:  Will the MA-PD or PDP have the same formulary as before or will it use a different formulary?  

A:  This is from Rick Tapnio, senior account manager for Aetna Federal Plans:  Prescription drug benefits are improving in 2024 for members with Medicare. Eligible members will see lower copays and a lower limit on out-of-pocket costs with Aetna Medicare RX® offered by SilverScript®. The same drugs are covered but the formulary list is different. Therefore, some drugs could be covered under a different tier. However, it doesn't necessarily mean members will pay more because copays and coinsurance may be lower even if drugs move to a higher tier.

Q: Will the coverage be less restrictive with lower copays? 

A:  The greatest impact for members will be lower copays and less coinsurance coming out of their pocket.  

Q: Which one of these two would someone use if covered under Aetna Direct as a retiree?

A: The PDP formularies will be on our website once they become available. Members can also connect with their plan's Member Services to research specific drugs thoroughly.  After you reach your individual maximum out-of-pocket costs of $2,000, Aetna FEHB Plan will pay the rest of your annual drug costs.

Q:  Am I correct in thinking that if I don't opt out of this drug enhancement I will be ineligible for drug coupons from manufacturers because I will have drug benefits from Medicare?

A: In general, most manufacturer's discount programs exclude those who are enrolled in a Part D program. To know for sure, you must check the eligibility requirements for the copay card/program. Below is a sample of the wording for one of the cards that is often asked about: Eliquis. Enrollment in the enhanced Medicare Prescription Drug Program (MA-PD or PDP) is a Part D plan and a member would not meet the requirements for eligibility for this copay card. However, members enrolled in MA-PD or PDP can get a 90 day supply of Eliquis for a very low rate.  

ELIQUIS copay card has the following eligibility requirements:  

  • You are insured by commercial insurance and your prescription insurance coverage does not cover the full cost of your prescription, that is, you have a co-pay obligation for ELIQUIS;
  • You do not have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs Department or Defense Department programs; patients who move from commercial plans to state or federal healthcare programs will no longer be eligible;
  • You are 18 years of age or older; and
  • You are a resident of the United States, Puerto Rico, or other select U.S. Territory.

Q: Does the out-of-pocket expense ceiling under the Medicare PDP enhancement take into account my out of pocket expenses incurred under my overall FEHB Plan catastrophic spending cap AND those incurred under the new Medicare PDP?   

A:  If you are enrolled in both Parts A and B of Medicare, there should be no, or very little, out-of-pocket medical expenses incurred as many plans (but not all) will waive your deductible, copays and coinsurance for both inpatient and outpatient medical services (not pharmacy) when Medicare A and/or B are the primary payer. The only way to reach the catastrophic out-of-pocket maximum with your FEHB plan when you have Medicare A and B as primary payer (with plans that wrap around Medicare by waiving your cost-sharing including deductible, copays and coinsurance) is by having extremely large prescription drug expenses. One of the benefits of the MA-PD and PDPs is a lower cap on out-of-pocket prescription drug expenses. If you don't enroll in Part B of Medicare, you will be required to pay cost-sharing for outpatient care which can add up to a much higher catastrophic cap on your out-of-pocket costs.  See Section 4 of your plan brochure, Your Cost for Covered Services and also Section 9 of your plan brochure, Coordinating Benefits with Medicare and Other Coverage.  

For example, according to Jennifer Vendur, account manager for the federal employee BC/BS Program, BC/BS Standard option will have a $2,000 Rx out-of-pocket max for 2024 and for Basic Option there will be a $3,250 Rx out-of-pocket max. Using Standard option self-only numbers as an example: The overall BC/BS Standard Option out-of-pocket maximum is $6,000. The PDP has a limit within that $6,000 that says you don't have to pay more than $2,000 toward prescription drugs. The $2,000 is part of the $6,000 – not in addition to it. If you have Medicare A and B as your primary coverage, regardless of your prescription drug copays, you would not spend more than $2,000 out-of-pocket in 2024 since your inpatient and outpatient medical cost-sharing is waived when Medicare is the primary payer. Every time you pay a copay or coinsurance (%) for a prescription on the PDP, this counts toward the Rx out-of-pocket max. Once you hit the $2,000 max, you don't pay any more Rx copays or coinsurance  for the remainder of the calendar year. These amounts also count toward the overall out-of-pocket maximum of $6,000. The only people who will continue to pay medical copays are those without both parts of Original Medicare (A and B). If you opt out of PDP, your prescription drugs still count toward your out-of-pocket max, you just don't get the $2,000 Rx cap – everything applies to the $6,000 out-of-pocket max, just like it does now.

Vendur further explained that under the BC/BS PDP, the formularies are expanded. They include all Medicare Part D drugs PLUS everything on the traditional formulary for that plan. For example, if a drug is on the traditional formulary for Standard Option, it will also be on the PDP Standard Option formulary. If the drug is on the traditional formulary for Basic Option, it will also be on the PDP Basic option formulary. However, just like now, the Standard Option prescription drug formulary is different from the Basic Option formulary. 

Here are some benefits under the Inflation Reduction Act of 2022 that apply to MA-PDs and PDPs available in many FEHB plans for 2024:

  • You will not pay a separate premium for your prescription drug coverage although some higher income participants may need to pay a Part D Income-Related Monthly Adjustment Amount (IRMAA). If your income is above a certain limit  (in 2024, above $103,000 if you file individually or $206,000 if you're married and file jointly), you'll pay an extra amount in addition to your plan premium (sometimes called "Part D-IRMAA"). If you are subject to the Part D IRMAA surcharge, you are permitted to opt-out of the PDP and MA-PD, but doing so will result in a loss of the other benefits of this coverage. 
  • Beginning in 2023, Part D enrollees will pay no more than $35 per month for covered insulin products in all Part D plans.
  • There is no cost sharing (i.e., copay) for adult vaccines covered under Part D
  • Drug manufacturers will be required to pay rebates for drug prices that rise faster than the rate of inflation, which could impact costs for Part D enrollees. 
  • There is a maximum out-of-pocket spending cap on prescription drugs under Part D (MA-PD and PDP).  See your FEHB plan for additional details.  

Here are some additional things to know about these new benefits designed to make prescription drugs more affordable:

  • If you or someone you know struggles to pay for their healthcare expenses, there is Extra Help (sometimes called Low Income Subsidy or LIS) that Medicare offers to people with low incomes and limited assets. If you qualify, you'll get help with drug costs that Medicare doesn't cover including your plan premium, drug deductible and prescription copays. Depending on your income and resources, you could save an average of $5,000 per year.  Less than half of the people eligible for Extra Help sign up. 
  • If you decide you no longer wish to be enrolled in the PDP or MA-PD, you may contact your FEHB plan to cancel your enrollment at any time.  You may re enroll during a subsequent open season period.  
  • The PDP plans have automatic enrollment, so the only thing you may need to do if you don't want this coverage is to opt-out.  However, if you are interested in a MA-PD option under one of the many FEHB plans offering this Part C / Medicare Advantage benefit, you will need to "opt-in" to receive these benefits.  Contact your FEHB plan for additional information.

Remember, Open Season will run from Nov. 13 to Dec. 11, 2023.


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