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[TSPStrategy] Why federal workers should consider an HSA

[TSPStrategy] Why federal workers should consider an HSA

https://www.govexec.com/pay-benefits/2024/10/why-every-fed-should-consider-hsa/400443/?oref=govexec_today_nl&utm_source=Sailthru&utm_medium=email&utm_campaign=GovExec%20Today:%20Oct.%2024%2C%202024&utm_term=newsletter_ge_today

Why federal workers should consider an HSA

COMMENTARY | There is something exciting about having a health insurance plan that can reduce your taxes while also providing tax-free investment growth.

With open enrollment less than a month away and the average premium increase at 13.5%, millions of federal employees are reevaluating their health insurance plans. While health insurance may not be the most exhilarating topic, there is something exciting about having a health insurance plan that can reduce your taxes while also providing tax-free investment growth. These are two benefits of a Health Savings Account, which according to the Consumer Financial Protection Bureau have surged in popularity, with the number of accounts increasing over 500% since 2013.

What's the Big Deal?

Selecting a High Deductible Health Plan with an HSA feature provides: (1) Generally less expensive bi-weekly premiums, (2) part of your bi-weekly premium is returned to you, (3) HSA contributions are pre-tax (reducing your taxable income), (4) HSA contributions made via payroll deduction are not subject to payroll tax, (5) you can invest your contributions in a variety of investments, (6) your money grows tax-free, (7) the HSA is yours and is completely portable – you keep it even if you leave the government or change to a health plan that's not HSA eligible, (8) no "use or lose" like with an FSA, (9) no income restrictions to contribute, (10) no Required Minimum Distributions, (11) HSA distributions are tax and penalty-free if used for qualified medical expenses (there are a lot of expenses that qualify), (12) distributions are tax and penalty-free to reimburse yourself for medical expenses that were paid out-of-pocket at any time after you established your HSA, and (13) once you reach age 65, distributions are penalty-free even if not used for qualified medical expenses (however, ordinary income tax will apply if for non-medical expenses).

HSA Eligibility

  1. Covered by a High Deductible Health Plan
  2. No other health insurance coverage
  3. Not enrolled in Medicare
  4. Can't be claimed as a dependent on someone else's tax return

Qualified Medical Expenses

Don't think of just traditional healthcare/medical expenses. Qualified expenses include a wide variety of items to include cold medicine, pain reliever, sleep aids, allergy medication, over-the-counter drugs, certain skincare products, heartburn tablets, band-aids, sunscreen, contraceptives, prescriptions, after-sun aloe, etc. For a full list of qualified medical expenses see IRS Publication 521 or visit HSA Store. If you have a family plan, expenses incurred for you, your spouse, and dependents are all eligible.

How Does This Work? My Real-Life 2024 Example.

(1) I was covered by the FEHB Plan #341 (GEHA HDHP)

(2) I paid bi-weekly health insurance premiums of $71.45

(3) Every month I received a deposit of $83.33 in my HSA account. This amount represents the $1,000 (self-only) premium pass-through (PPT) feature where a portion of your premium is returned. PPT in 2025 for self-only will remain $1,000 and for family plans will be $2,000.

(4) Since the total 2024 HSA contribution limit was $4,150 for self-only, and the $1,000 PPT counts towards the IRS limit, I contributed the remaining allowable amount ($3,150) from my paycheck throughout the year. This $3,150 of personal contributions was not subject to payroll tax and it reduced my taxable income. Contributions went straight from my paycheck to the custodian, HSA Bank. Note: Your personal contributions can go to any HSA custodian, or be rolled over from HSA Bank to a different custodian (Fidelity, Lively, etc.), but with the FEHB GEHA plan, the $1,000/$2,000 PPT will always be sent to HSA Bank. 

(5) When the $83.33 PPT and my personal contributions hit my HSA Bank account, they automatically get invested in a low-cost passive index fund (not an investment recommendation). This money is now invested and will grow tax-free, similar to a Roth IRA, but better since those are pre-tax dollars going in. Note: you don't have to invest your HSA money, you could leave the HSA dollars in cash and use your HSA debit card to pay for qualified medical expenses.

(6) When I had medical expenses, I paid OOP, recorded it on a spreadsheet, and saved a picture of the receipt in a cloud folder. I can reimburse myself for these expenses at any time, even if it's 20-years from now and I'm no longer a government employee and not covered by an HSA eligible plan. The HSA money is mine to use for medical expenses, reimburse myself for expenses paid OOP, or use for anything after age 65 without penalty.

I view my HSA as a quasi-retirement fund, specifically aimed at handling medical expenses, Medicare Part B premiums, and/or long-term care. In extreme cases, it could even act as an emergency fund since I can technically withdraw money tax and penalty-free for all of the documented OOP medical expenses I've paid since I was first covered in 2020.

How Much Can You Invest in 2025

$4,300 for self-only plans and $8,550 for family plans. Individuals who will turn 55 in calendar year 2025 can contribute an additional $1,000 catch-up. For spouses with family coverage, each spouse can contribute an additional $1,000 to their individual HSA account. Remember, these contribution amounts are reduced by the PPT.

There is a unique situation where an adult child, not claimed as a dependent, but covered under their parent's family HDHP could also contribute $8,300 to their own HSA. For example, your 25-year-old child lives on their own, files their own return as a single filer, provides more than half of their own support, but is still covered by your HDHP family plan (allowable until age 26 under the Affordable Care Act). While the parent's HSA cannot be used to pay for the child's expenses, this child could open their own HSA and fund it with the full $8,300 family contribution amount, completely separate from the parents HSA. An important note, if your child could be claimed as a qualifying child dependent, but you choose not to claim them, they are not eligible for this HSA opportunity. The key is that they are not eligible, it's not enough to simply not claim them. For more details on what counts as a qualifying child consult IRS Publication 501.

Tax Savings (hypothetical with 2024 numbers)

Tax filing status: Married Filing Joint

Combined Income: $180,000

Standard Deduction: $29,200

Taxable Income: $150,800

State Tax: 5.75%

HSA Contributions via Payroll Deduction: $6,300

Federal Tax Savings: $1,386

State Tax Savings: $362

Payroll Tax Savings: $481

Total Tax Savings = $2,229

Compounding Magic – Just 5-Years Can Be Powerful

You and your spouse contribute and invest $6,300 ($242 per pay period) plus the $2,000 PPT ($166/mo.) every year for 5-years. We'll assume a 7% annualized growth and that the IRS contribution limit doesn't change. After 5-years, you'd have about $49,000. $31,500 came from your contributions, $10,000 from PPT, and the rest from growth. What could this turn into for a new employee and one approaching retirement?

Scenario 1: You're a 30-year-old new employee and life hasn't become too complicated yet. You don't have the new house, a bunch of kids running around, broken arms, braces, college costs, etc. You decide you're going to take advantage of the HSA for just 5-years. You leave it alone and don't touch it until it's time to pay for Medicare Part B premiums 30-years later. With a 7% annualized growth rate and no additional contributions, your $49,000 from age 35-65 has grown to $373,000. Obviously, inflation will make this worth less, but even with a 3% inflation rate, your $31,500 contribution would be worth about $153,000. Don't forget the $11,100 in tax savings from the 5-years you contributed (using the scenario above).

Scenario 2: You're a 45-year-old Foreign Service Officer or Special Category Employee approaching retirement at age 50. Life has become simple as an empty nester. You and your spouse are still relatively healthy, minus a few creaking knees and popping shoulders. You have the cash flow and want to try this HSA thing out for 5-years. With a 7% annualized growth rate and no additional contributions, your $49,000 from age 50-65 has grown to $135,000, factor in 3% inflation and it would be worth roughly $87,000, on top of the $11,100 tax savings (using the scenario above).

HSA Bank's New HSA Invest Program

During my first four years with HSA Bank, I transferred my contributions and the PPT to Charles Schwab in order to invest the money. As of this year, HSA Bank is no longer allowing this. Instead, they've created their own investment platform called "HSA Invest". This is essentially a brokerage account built directly into the HSA Bank platform. At first, it was advertised that everyone would pay annual fees just for having an account (not very popular obviously). However, in September 2024, HSA Bank sent an email clarifying the fee structure for HSA Invest.

For those who are comfortable picking their own investments, there is a "Choice" option which costs GEHA members 0.00% fee. If you want guidance and a recommended list of funds to invest in, you can use the "Select" option which costs 0.25% annually. Finally, if you want your investments managed by an investment advisory firm, you can pay 0.35% annually with the "Managed" option. If someone has a "Managed" or "Select" account with a cash balance of $7,500 or more, the fees will be waived for that quarter.

I understand that people are upset about HSA Invest and don't like being told where to keep their money. Despite the backlash that's come from the federal employee community, from what I've seen, HSA Invest is not the villain many have made it out to be. I've been using HSA Invest since the rollout and have had no issues. I transferred my money back from Charles Schwab to HSA Bank, enrolled in HSA Invest, selected the one mutual fund I want to invest in, and set up automatic investing for every contribution and PPT deposit. Having HSA Invest versus Charles Schwab results in one less log-in for me to keep track of, keeps my financial life simple, and has cost me $0.

If things change with the HSA Invest platform or if they start to charge fees for the "Choice" option, I'll create an HSA account at a different custodian and move my money there. Remember, even in this scenario, the PPT would go to HSA Bank and I'd have to transfer it over.

If you are unhappy with HSA Invest and plan to move funds from HSA Bank to a new custodian there are two ways to do this. A direct trustee-to-trustee transfer, where the funds move directly from HSA Bank to your new custodian. Or, you can do a 60-day rollover where a check is sent to you first. Be careful with the 60-day rollover option. If the money is not deposited in the new HSA account within the 60-day window, the IRS will view this as a withdrawal and you could be on the hook for tax and 20% penalty. Also, you are limited to one 60-day rollover per 12-month period (not calendar year).

Premiums

Here are the 2025 premiums for GEHA HDHP vs. two popular Blue Cross Blue Shield plans that I also consider annually.

GEHA HDHP Self-Only (341): 2025 bi-weekly premium $76.27 ($1,983 annual) – an increase of $4.82

GEHA HDHP Family (342): 2025 bi-weekly premium $201.52 ($5,239 annual) – an increase of $12.74

BCBS Basic Self-Only (111): 2025 bi-weekly premium $113.16 ($2,942 annual) – an increase of $17.42

BCBS Basic Family (112): 2025 bi-weekly premium $303.61 ($7,893) – an increase of $41.01

BCBS Standard Self-Only (104): 2025 bi-weekly premium $174.81 ($4,545 annual) – an increase of $24.02

BCBS Standard Family (105): 2025 bi-weekly premium $424.65 ($11,040 annual) – an increase of $53.97

With the PPT factored in, a self-only plan's net annual premium in 2025 will be $983 and the net annual premium for a family plan will be $3,239. As federal employees, we pay roughly 25% of our total insurance cost. Here are the numbers for GEHA HDHP: $76.27 (employee bi-weekly premium) / $305.10 (total employee + employer bi-weekly premium) = 25% paid by the employee.

High-Deductible Sounds Expensive

If your goal is to have the absolute least amount of OOP expense, an HDHP is probably not the right fit. Everyone's health situation and medical needs are different. Even someone in great health may not want to roll the dice on the possibility of paying OOP regardless of the lower premiums, tax savings, and investment feature. However, make sure you do your homework using the OPM FEHB plan comparison site. There are other plans that aren't labeled HDHP and still have deductibles of $600/$1,200. Once you factor in the HDHP's $1,000/$2,000 PPT plus lower bi-weekly premiums, your regular plan could cost you more on a net basis than the HDHP.

How Much Could it Cost? 

First and foremost, I want to stress the preventative care aspect. Things like annual physical exams, routine screenings, immunizations, two dental cleanings, etc. are generally covered by insurance before hitting your deductible, without any cost sharing, coinsurance, or copays. So, you should not be skipping your annual physical or dental cleanings because you're scared to see the bill.

Deductible – Just like with car insurance, the deductible is the amount you pay OOP before plan benefits begin. The GEHA HDHP 2025 in-network deductible is $1,650 for self-only and $3,300 for self plus one and family coverage.

Coinsurance – Coinsurance kicks in after you've met your deductible. Primary care office visits, labs, x-rays, emergency room visits, and specialists have a 5% coinsurance if in-network. If you visit the doctor's office and they bill $100, but the in-network provider has an agreement with GEHA to accept $80 as the allowable amount, you'll pay $80 if you haven't met your deductible yet. This $80 will be applied towards your annual deductible. If you have met your annual deductible ($1,650/$3,300) and the coinsurance is 5% of the allowable amount, you would pay $4.

Maximum Out-of-Pocket/Catastrophic Protection – This is the maximum you'll pay for coinsurance, co-pays, and deductibles (medical care and prescriptions) combined before insurance pays 100% of covered services. The in-network 2025 OOP maximum is $6,000 for self-only and $12,000 for family coverage. Out of network is $8,500 and $17,000. Remember, this catastrophic limit is for coinsurance, co-pays, and deductibles combined. Insurance will still kick-in once you reach your annual $1,650/$3,300 deductible.

What If I Withdraw HSA Money Before Age 65 for Non-Medical Purposes? 

You'll pay ordinary income tax and a 20% penalty.

What If I Don't Want to Invest the Money?

You can still save by paying for medical expenses with pre-tax dollars. If you pay for a medical expense with $50 from your bank account, and you're in the 24% tax bracket, that actually cost you about $65 because you had to earn $65, pay 24% tax, and then net $50 in your bank account. If instead you pay $50 for something with $50 of pre-tax HSA money, it actually cost you $50.

What If I'm Not Healthy?

Electing to have an HDHP is a very personal decision. I don't know your financial or health situation, so nothing in this article should be seen as advice, simply a suggestion to consider. 

An HDHP may be optimal for individuals with: (1) no healthcare needs, or (2) a lot of healthcare needs. Why those with a lot? Because most traditional insurances won't exclude co-pays and drug costs after hitting the annual catastrophic limit. This means that with a traditional plan, you could pay your catastrophic limit and still be on the hook for co-pays and prescriptions. On the other hand, OPM states that, "With an HDHP, once you hit the catastrophic limit, there is no out-of-pocket expense for covered in-network services."

What If I'm Too Healthy?

Congrats for winning the human biology lottery! However, it's still unlikely that you'll never have medical expenses. You can always reimburse yourself at any time in the future for those every day qualified medical expenses.

HSA funds can also be used to pay for Medicare Part B and Part D premiums and long-term care (LTC) insurance premiums. The odds are good that sometime before you die, you'll have some medical expenses that could be paid with tax-free money that compounded for decades. Worse-case scenario you're super human and this account morphs into an account that's very similar to a Traditional IRA or pre-tax 401(k) at age 65. You'll pay income tax but no penalty.

Downsides

(1) California & NJ don't recognize the HSA and your contributions won't reduce your state income tax. Dividends, interest, and capital gains are also taxable at the state level. You'll still reap the federal tax benefits.

(2) If you die, your spouse can inherit your HSA as if it was their own. If they die, or if you have a primary non-spouse beneficiary, the account is no longer classified as an HSA when you die. When this happens, the fair market value of the account becomes taxable to the beneficiary in the year in which you die. This could create a tax issue for non-spouse beneficiaries. There are ways to plan around this issue and you should consult a financial professional if it's a concern.

Reporting

There's no heavy lifting at tax time. You'll receive a 5498-SA from your HSA custodian showing how much you contributed. A 1099-SA will be issued if you took distributions from your account. At tax time you'll need to file IRS Form 8889 documenting your contributions, your employer's contributions, any distributions taken, and any penalties owed. You don't have to provide receipts at tax time showing that you paid for qualified medical expenses, however, you'll still want to save the receipts and have a good tracking system in place in the event of an audit.

Tyler Weerden, CFE is a financial planner and the owner of Layered Financial, a Registered Investment Advisory firm located in Arlington, Va. In addition to being a financial planner, Tyler is a full-time federal agent with 15 years of law enforcement experience on the local, state, and federal level. He has served in both domestic and overseas Foreign Service assignments. 

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[TSPStrategy] A Senate bill targeting teleworkers’ locality pay now has its companion in the House

[TSPStrategy] A Senate bill targeting teleworkers’ locality pay now has its companion in the House

https://www.govexec.com/pay-benefits/2024/10/senate-bill-targeting-teleworkers-locality-pay-now-has-its-companion-house/400460/?oref=govexec_today_nl&utm_source=Sailthru&utm_medium=email&utm_campaign=GovExec%20Today:%20Oct.%2023%2C%202024&utm_term=newsletter_ge_today

A Senate bill targeting teleworkers' locality pay now has its companion in the House

Legislation introduced by Rep. Dan Newhouse, R-Wash., would bar federal workers from receiving locality pay if they telework at least once per week, a move that could amount to a 30% pay cut for many feds.

AHouse Republican has joined a nascent effort to issue upwards of 30% pay cuts to federal employees who engage in regular telework by depriving them of their locality pay.

Rep. Dan Newhouse, R-Wash., last week introduced the Federal Employee Return to Work Act (H.R. 10014), a measure that would bar federal employees who spend at least one day per week—or 20% of their work hours—on telework from receiving the locality pay determined by the location of their official work station, instead considering them part of the "Rest of U.S." locality pay area, regardless of where they live or work. It serves as the House companion to legislation introduced by Sen. Bill Cassidy, R-La., in August.

For federal workers in cities like New York, San Francisco or Washington, D.C., locality pay can amount to as much as 30% of their salary.

"The federal government pays for massive offices for agency employees in Washington, D.C., and we now know that 17 of the 24 federal agencies are using less than a quarter of their space because of work from home employees," Newhouse said in a statement. "If agencies wish to allow their employees to work from home, that is their right to do so. But if they do, then the government should not be paying locality bonuses to those employees and they should be treated like any other work from home federal employee that doesn't receive such a bonus."

Newhouse's statement refers to a 2023 Government Accountability Office report measuring federal building utilization in the Washington, D.C., area. But in the intervening year, many federal agencies have updated their telework policies to require workers at their headquarters to spend more time on "meaningful in-person work," typically requiring feds to spend about half their work time at official work sites.

Despite popular misconceptions, locality pay is not designed to supplement federal workers' income if they live in high-cost areas; rather, the goal is to reduce pay disparities within a region between federal and private sector workers to within 5%, so that agencies can better compete for talent.

Additionally, remote workers—that is, federal employees who are not generally expected to commute to work—already are granted locality pay for where they live rather than the location of an official work site. And federal HR leaders have repeatedly testified before Congress that they conduct oversight to ensure feds do not take advantage of telework agreements to receive more locality pay than they are entitled.

And while the bill makes exceptions for federal employees with disabilities, members of federal law enforcement and the Foreign Service and active duty military, it would also apply to the 85% of the federal workforce whose homes and official worksites are outside of the Washington, D.C. area.

"Federal employees get paid extra to work in higher-cost cities," Cassidy said in a statement applauding the introduction of Newhouse's bill. "Why should they get paid? If you don't show up for work, you don't get paid at the same rate just for teleworking."

Notably, Newhouse has thus far not introduced a companion bill for Cassidy's other telework proposal, which would remove locality pay the annuity calculations under the Federal Employees Retirement System for all new federal employees, regardless of location or usage of workplace flexibilities.

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[TSPStrategy] 10 important facts about Medicare - Some things you need to know when approaching Medicare eligibility

[TSPStrategy] 10 important facts about Medicare - Some things you need to know when approaching Medicare eligibility

https://www.govexec.com/pay-benefits/2024/10/10-important-facts-about-medicare/400347/?oref=govexec_today_nl&utm_source=Sailthru&utm_medium=email&utm_campaign=GovExec%20Today:%20Oct.%2018%2C%202024&utm_term=newsletter_ge_today

10 important facts about Medicare

Some things you need to know when approaching Medicare eligibility.

Most federal employees and annuitants know that they are eligible for Medicare benefits at age 65. However, what isn't fully understood is how and when to enroll in one or more parts of Medicare. Here are some things that you need to know when you are approaching Medicare eligibility: 

#1 Initial Enrollment Period: If you are not receiving Social Security or RRB as you approach age 65, you may enroll in Medicare starting three months before your 65th birthday month and up to three months after. This is your IEP.   

#2 Medicare Part A: Hospital Insurance can begin as early as age 65. It doesn't matter if you are covered by other health insurance or whether you are working or retired. There is no premium for Part A if you receive or are eligible to receive benefits from Social Security (or the Railroad Retirement Board-RRB) or your spouse (living or deceased, including a divorced spouse) receives or is eligible to receive Social Security (or RRB benefits). While you are covered by Federal Employees Health Benefits or the Postal Service Health Benefits program as a current employee, Medicare will pay second to your employer coverage based on current employment. This also applies to your Medicare eligible spouse if they are covered by your current employment health coverage. You may also qualify for Medicare if you are the dependent parent of a fully insured deceased child. For those individuals who are receiving Social Security retirement benefits, Medicare enrollment is automatic. If you are 65 or older and do not receive Social Security retirement benefits, you may delay enrollment in all parts of Medicare if you wish to continue to contribute to a Health Savings Account with a High Deductible Health Plan. 

#3 Medicare Part B: Outpatient coverage or "doctor's insurance." You can only sign up for Part B during designated enrollment periods. If you don't enroll in Part B when you're first eligible, you may have to pay a permanent late enrollment penalty. If you're already getting benefits from Social Security or the RRB, you'll automatically be enrolled in both Part A and Part B starting the 1st day of the month you turn 65. If your birthday is on the 1st day of the month, Part A and Part B will start the 1st day of the prior month. If you're under 65 and have a disability, you'll automatically get Part A and Part B after you get disability benefits from Social Security for 24 months. Also, you'll automatically get Part A and Part B after you get certain disability benefits from the RRB. If you have ALS, you'll get Part A and Part B automatically the month your SSDI benefits begin. 

#4 Premiums for Medicare Part A and Part B: Medicare Part A is financed primarily through payroll taxes, which are paid by both employees (1.45% of earnings) and employers (matching 1.45%). The self-employed pay both shares of the tax, 2.9% of net earnings from self-employment. Because you've paid this tax, there is no premium for Medicare Part A. People aged 65 or older, who are citizens or permanent residents of the United States are eligible for Medicare Part A at no cost at age 65.   

Medicare Part B is primarily financed through premiums that are deducted from Social Security retirement benefits or through other methods, if not receiving or eligible for Social Security retirement. Other ways to pay for Part B are outlined here: https://www.medicare.gov/basics/costs/pay-premiums 

The standard Medicare Part B premium is projected to increase to $185 per month in 2025, up from $174.70 in 2024. Some beneficiaries may pay higher premium rates based on their income. In 2024, if you file an individual tax return and your Modified Adjusted Gross Income (MAGI) in 2022 was more than $103,000, you will pay an additional amount known as the Income Related Monthly Adjustment Amount (IRMAA).  If you file a joint tax return, you will be affected by IRMAA if your MAGI is over $206,000. The 2025 rates will be announced later this year. 

If you're not sure if you're enrolled in Medicare Part A or Part B (yes, there are those who don't know if they signed up at 65 or not), look in your wallet to see if you have the red, white, and blue Medicare card.   You can call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778) to check your enrollment status. You can also visit your local Social Security office and maybe the easiest way, is to log into your MyMedicare.gov account to check your status. You can also log into your My Social Security account. 

#5 General Enrollment Period (GEP) for Part B If you don't enroll in Medicare Part B during your IEP, you have another chance each year to sign up during a GEP from January 1 through March 31. Your coverage starts the 1st day of the month after you sign up. However, you may have to pay a late enrollment penalty for as long as you have Part B coverage. Your monthly premium will go up 10% for each 12-month period you were eligible for Part B, but didn't sign up for it. 

#6 Special Enrollment Period is available if you're covered under an employer group health plan and the coverage is through current employment.  If you are covered by "current employment" health coverage, either from your own or your spouse's current employment, you may sign up for Medicare Part B during your SEP. This means that you may delay enrolling in Medicare Part B without having to wait for a GEP and paying the penalty for late enrollment.  The SEP rules allow you to enroll in Medicare Part B any time while you or your spouse have a group health plan based on current employment or enroll in Medicare Part B during the 8-month period that begins the month after the employment ends or the group health coverage ends, whichever happens first. 

You can't enroll using an SEP until your IEP is over. When you enroll in Medicare Part B while you're still in the group health plan, or during the 1st full month when you are no longer in the plan with current employment, your coverage begins either on the 1st day of the month you enroll or, by your choice, on the 1st day of any of the following 3 months.  If you enroll during any of the remaining 7 months of the SEP, your Medicare Part B coverage begins on the 1st day of the following month. If you don't enroll by the end of the 8-month period, you'll have to wait until the next GEP, which begins January 1 of the next year.  

#7 Coordination of Medicare with FEHB/PSHB.  Under the new PSHB, if you are under age 64 on January 1, 2025, you must enroll in Medicare Parts A and B when you are retired and 65 to continue coverage under PSHB.  Otherwise, enrollment in Medicare is optional for FEHB and PSHB (for current postal retirees and postal employees who are 64 or older on January 1, 2025) enrollees.  Most annuitants enroll in Original Medicare (Parts A and B).  Once retired, Medicare becomes the primary payer and your FEHB/PSHB pay as secondary payer.  There are FEHB/PSHB plans with low rates that complement Medicare by waiving cost sharing (deductible, copays, and coinsurance) when Medicare is the primary payer.  Also look for plans that provide a rebate or reduction in your Part B premium.  After age 65, it may be important to have low prescription copays as well as generous coverage for physical, occupational or speech therapy benefits; durable medical equipment; coverage for hearing aids; and skilled nursing care.   

#9 Medicare Advantage, Part C Many plans provide a Medicare Advantage option that may provide additional benefits such as gym membership, meal delivery after a hospital stay, dental, vision, transportation to non-emergency medical appointments and more.  You can generally see any health care provider that participates in Medicare and accepts the plan. Accepting the plan means the doctor is willing to treat you and bill the Medicare Advantage provider.  Your FEHB/PSHB may be able to contact your doctor on your behalf to explain how the plan works. If your doctor or hospital refuses to directly bill the Medicare Advantage plan, they may ask that you pay the full allowable amount. In that case, you can pay the doctor and then submit your claim to the plan. You will be reimbursed for the cost of the claim, less your copay.  Contact the Plan for additional information regarding how you will receive care.  These Part C Medicare Advantage plans available through your FEHB/PSHB plan are not the same as those advertised on TV or those on the plan finder at medicare.gov.   

#10 Medicare Part D, Prescription Drug coverage If Medicare Part A and/or B is primary, and you're enrolled in an FEHB/PSHB plan offering Medicare Part D, your prescription drug coverage will automatically become a Medicare Part D plan.  This could result in savings on your prescription costs. Your drugs will still be covered, but copays and coinsurance can be lower and out of pocket expenses on medications are capped at $2,000 / year (some currently have this limit, but all plans are included starting in 2026). If available, once you reach the $2,000 max for prescription drugs, you will pay $0 for prescription drugs. This $2,000 will also apply to the medical plan's total calendar year out-of-pocket maximum. There are some downsides to adding this coverage to your FEHB plan.  One negative is if you are a higher income enrollee.  There is an IRMAA surcharge for higher income retirees (like Part B IRMAA, but different rates).  With Medicare Part D coverage, you may not use a manufacturer's discount coupon. PSHB enrollees who are eligible for Medicare Part D must enroll in a Medicare Part D plan. This includes annuitants who are newly eligible for Medicare and their covered family members.

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