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: 

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

https://apwu.org/news/magazine/year-end-review

While I was planning on writing this weeks article about Medicare, it has come to my attention that quite a few people are trying to use PostalEASE to make changes to their healthcare. Unfortunately this quite frankly simple and easy tool is no long available to us, specifically for healthcare changes. You may still use it for all the other tools. 

Postal Employees wanting to make changes to their Health Plan need to do so by creating a login.gov account, by first visiting health-benefits.opm.gov. If technologically averse, by filling out and faxing in form SF 2809. While the form itself is 18 pages, you only need to fill out the last two. You can also make changes via phone, by calling the PSHB Helpline at 844-451-1261. I imagine if making changes over the phone, you will need to know your PIN number.

*** If you don’t know your PIN, there is a self-service reset option on Liteblue, but it will come to you via mail. So don’t waste time if you want to use this option.***

If you and technology are friends (or merely acquaintances), creating the login.gov account is fairly simple. I would recommend doing it on your phone, since to verify your identity,it will ask you to take a picture of your driver’s license. Otherwise, it will want you to go to a Post Office to verify your identity, and none of us want to go to the Post Office in our off time. 

If you had a Flex Spending Account with FSAFEDS this year, you will already have a login.gov account. Part of the reason the Post Office switched carriers this year was because FSAFEDS was hacked, and midway through the year, all account holders were required to use login.gov to access their account afterwards. 

***Even if you already have a login.gov account, you need to use the OPM link  get to the correct prompt to link to the Postal Service Health Benefits (PSHB).***

*Fun bonus fact, you can also link you Social Security Account to see where you stand as far as work credits, review your earnings history for a fun trip down memory lane of how poor you used to be (or alternatively wonder where all your money went), and (hopefully) fanaticize about retirement* 

If you have technical issues with your Login.gov account, Login.gov operates a 24/7 contact center via phone at (844) 875-6446 or website contact form.

***If/when you switch to the APWU CDO, you are going to see the full amount for the premiums, not the discounted amount that members who are career and have had a Federal plan for a year are entitled to. The Health Plan is aware of this problem. The CEO of the Health Plan met with OPM on 11/13/2024 to request that the APWU rate be displayed. We don’t yet have an update on the status of this request.***

Please keep in mind that in addition to being the Health Plan Coordinator, I am also a Steward and Auto clerk, during the busiest time of the year for postal workers. If I look a bit frazzled, it’s because I am! I can safely say that this goes for pretty much all of our Stewards and Officers this time of year. Please help us help you by telling a supervisor that you need to see a steward if you think you have a grievance. This helps to get us off the floor so we can devote our full attention to your issue. Sadly, unlike Batman, we cannot stalk the plant looking for violations. We were not left millions by our parents and have to work for a living. 

Unions, much like the government, work best when people are involved. We need the membership to keep us informed of what is going on, and to write statements. It is never a waste of anyone’s time to get a correct answer. Misinformation runs amok on the floor and it hurts everyone. 

Good luck and as always, I am happy to help! 

This week, as I zip around the state of West Virginia for Health Fairs, I wanted to take some time to share information with the membership about some benefits that their health plans provide that are lesser known. 

Some of these plans are included at no additional cost, and some have extra fees associated with them. This is by no means an exhaustive list, and truthfully, some can be a little difficult to find information on if you aren’t logged into your account with either the High or Consumer Driven Option.

Both High Option (HO) and Consumer Driven Options (CDO) include: 

Maven – World’s largest maternity virtual clinic. Available at no additional cost to members. 

You get your own Personal Care Advocate, who is a REAL PERSON that you keep for your whole journey. They also offer on demand classes and community forums.

21-month support track for both parents with about a 1-hour response time 24/7/365, and 48 hourturnaround for in person appointments. Unlimited video appointments with 35+ types of doctors. Go to Mavenclinic.com/join/overview for more information.

One Pass Select - This is a fitness and well-being basedsubscription-based network that provides access to over 16,000 gyms and studios. 

Members can use multiple locations during the same month and change locations at any time. It offers 5 different tiers and can be used nationwide. 

The first tier is digital and is $10, and they go up, with the most expensive being $159 a month. You can change tiers monthly, and each tier includes the one under it. onepassselect.com

Virtual Visits – These options allow you to connect with a doctor by phone or video. Doctors can treat a wide range of health conditions, including many of the same conditions as an Emergency Room visit or Urgent care, and may even be able to prescribe medications. Virtual visits are good for allergies, bronchitis, colds or flus, migraines, pink eye, rashes or sinus infections, behavioral health and many more. 

For High Option Members, the first two visits through Teladoc are free, and have a $10 copay after, per visit.

For Consumer Driven Option Members, you have access to Amwell, Teladoc, and Doctor on Demand at 15% of the plan allowance. In many cases Virtual visits are less expensive than an in-person office visit, and thereby can save you money in the long run. 

CDO only

Calm Health – Combines the sleep and mindfulness content of Calm with support for your mental and physical health and includes:

Mental health screenings to get personalized recommendations and track your journey,

Digital Programs to help you understand your mental health

Audio and video content and activities written by psychologists.

There is no additional cost, you can access it at any time, and anyone 16 years of age and older on the plan is eligible. To sign up, you need to log into your account with myuhc.com and click on the Coverage and Benefits link, and then go to the Mental Health Link. Around the middle of the page there is a link for Calm Health. If you try to download the app first you will run into issues. Ask me how I know. 

Carington Dental – This is a discount service, not a dental insurance. 

Find a participating dental office by calling theMember Services at

(800) 290-0523  or online at www.careington.com. Members get a fee schedule and fees stay locked for 4 – 5 years. The plan offers 20%-50% savings on most dental procedures. 

*** A word about Dental/ Vision Coverage and the APWU Health plans. The CDO does not provide any Dental or Visionbenefits, although you can submit for reimbursement for dentaland vision claims out of your Personal Care Account.  The Self plan is limited to $400 per plan year, and Self + One or Self and Family is limited to $800. The HO has benefits for Preventative dental benefits and will pay 70% of the allowed amount, and does include fillings and simple extractions. There are NO benefits for Major dental work (crowns, root canals, etc), and no vision benefits. To look at available dental and vision plans, visit benefeds.gov or visit the APWU Health Plan website for more information on their stand-alone dental plan. There is also a discount vision plan available to Union members via the Voluntary Benefits Plan.***

As a reminder, Open Season starts November 11th 2024, and goes through December 9th, 2024. While that may seem like a lot of time, it will go by quickly! You don’t want to be trying to fax in paperwork at 11pm on December 9th.  

Check back next week for some basic Medicare information!

Kayla Reynolds

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