Medicare overview

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Finally, as was promised! The Medicare Article! 

 

As many of you are aware, the changes are happening to our health care because of the Postal Service Reform Act (PSRA) of 2022. This new law also made changes in Medicare requirements for eligible current postal workers and retirees. Medicare (which is through the federal government, is not to be confused with Medicaid (through the state government) 

 

What is Medicare? 

 

Medicare is a federal health insurance program for: 

▪ People 65 years of age and older; 

▪ Some people with eligible disabilities under age 65; and, 

▪ People with end-Stage Renal Disease, which is permanent kidney failure requiring dialysis or a kidney transplant. 

 

Annuitants (i.e. Retirees)

 

The PSRA is designed, in part, to promote Medicare integration. Beginning Jan. 1, 2025, the PSRA requires certain Medicare-eligible Postal Service annuitants to enroll in Medicare Part B to keep their PSHB coverage in retirement. 

 

After Jan. 1, 2025, annuitants who are enrolled in Medicare Part B must stay enrolled to keep PSHB coverage, unless an exception applies. 

 

 

Medicare health plans (more specific coverage  information available for Medicare Parts  A and B here.) You can also root around on the Medicare.gov website, but I personally found it a bit hard to navigate. 

 

Part A (Hospital Insurance) - If you or your spouse worked at least 10 years in Medicare-covered employment, you qualify for premium-free Part A coverage. Most Postal Service employees, retirees and covered eligible family members are entitled to Medicare Part A at age 65 without additional cost. It covers inpatient hospital care, skilled nursing facility care, nursing home care, home health care and hospice. If you receive Social Security Benefits prior to your 65th birthday, you should be automatically enrolled. 

 

Part B (Medical Insurance) – You are charged a monthly premium for Medicare Part B. For more information on rates, visit Medicare.gov. It covers certain doctor services, outpatient care, preventive services and medical supplies. You may also pay a penalty if you do not sign up for Part B when you first become eligible. There is NO CAP to this penalty, and you will pay it as long as you have the Medicare Part B plan, so be vigilant! 

 

There are some exceptions to the Medicare Part B enrollment requirement under the PSHB Program. You may be responsible for providing proof of eligibility for the applicable exception(s) to the designated agency. They are :

-Residing outside of the United States and its territories. You are required to follow the policy and procedure set forth by the Postal Service to be eligible for this exception. This exception requires that an annual certification be submitted to the Postal Service with proof of residency. 

-Annuitants who are enrolled in healthcare benefits provided by the Department of Veterans Affairs. 

- Eligibility for health services provided by the Indian Health Service. 

 

Part C (Medicare Advantage plans) – Medicare Advantage plans are Medicare- approved plans from a private company that offers an alternative to Original Medicare (Parts A and B) that provides health and drug coverage. CAREFUL WITH THESE. Private plans are required by law to let you know they are not part of a Government plan. If you see the phrase *Non Government Entity* be wary. 

 

***Both the High Option and Consumer Driven Option coordinate with Medicare and have their own benefits, but the High option is more advantageous. More about those specific benefits next week!***

 

Part D (Prescription coverage) – A standalone prescription drug plan with Medicare that helps cover the cost of prescription drugs. Medicare Part D will be included in all PSHB plans for Medicare eligible participants. You will not have to pay a separate premium for prescription coverage. Each PSHB plan will specify how your prescription coverage works in combination with Medicare Part D. If you drop part D, you WILL NOT have prescription coverage under the PSHB plan. You can re-enroll during open enrollment however. 

 

Still have questions? Of course you do! Medicare can be complicated and has what feels like 40 billion rules. This article is not meant to be exhaustive. While information on the workroom floor can be scant or, more likely, highly inaccurate, there is a lot of information available on LiteBlue. As a matter of fact, most of the information in this article was blatantly plagiarized from a booklet available on Liteblue. To find my source material, log in to your Liteblue account and go to MyHR. From there go to the Pay & Benefits tab, and then scroll down until you see the Postal Service Health Benefits link. Click on it. Scroll to the PSHB resources link. Click on that and then scroll further down until you see the heading “PSHB tools.” The third link under this heading is my source material. There is a lot more information on there than I was able to put in this article. I see you all on your phones, so I know you have time to research! An educated membership is an empowered one. 

 

Keepingposted.org has all sorts of useful links and information for your burning Medicare questions as well. Medicare can be complicated! Make your life easier and reach out to retirementbenefits@usps.gov or call (833) 712-7742 for answers to your retirement questions. 

 

Speaking of Retirement, keep in mind that, for whatever reason, Retirement is NOT a Qualifying Life Event. This means that any changes you wish to make to your insurance coverage will need to happen either during Open Enrollment or during a Qualifying Life event (Marriage, Divorce, birth or death, etc.)Becoming eligible for Medicare IS a Qualifying Life Event. Visit  OPM for a more exhaustive list of events that allow you to change insurance coverage. 

 

If you have been enrolled in the FEHB/PSHB Program from your first opportunity to enroll or for the full five years of service immediately preceding retirement, you may carry your coverage into retirement. All 5 years are not required to have been on the same plan. 

 

As I said above, next week I will cover some benefits that the APWU health plans have for Medicare! Remember that Open Enrollment ends December 9th, and it will be here much faster than you think it will be. 

 

Kayla Reynolds