Beginning in 2025, OPM is adding stricter eligibility requirements to try to root out ineligible enrollees in the Federal Employees Health Benefits (FEHB) program — something that’s been high on GAO’s radar for at least the last few years. A 2022 GAO report showed that OPM spends up to $1 billion each year on ineligible participants erroneously enrolled in FEHB.

“One of the biggest benefit systems in the country, and for decades, nobody checked these things,” Comptroller General Gene Dodaro told lawmakers on the House Oversight and Accountability Committee during a June 13 hearing.

Each year, GAO releases a report of the programs and spending areas across the federal government that could lead to significant cost savings for agencies. The changes that GAO recommends aren’t always complex, but to be able to implement the measures, agencies need resources, Dodaro said.

“This isn’t rocket science — I mean, it’s basically looking at those things and doing some good auditing,” Dodaro said. “It could be tackled as soon as the resources could be marshaled to do it.”

Agencies often ‘slow to act’

By putting more controls in place and creating stricter measures on who can actually enroll — and stay enrolled — in FEHB, OPM should be able to more effectively address the cost issues, GAO said. Identifying ineligible dependents has remained a top challenge for FEHB since 2018, according to OPM’s inspector general office.

“[OPM] recognized the significance of the issue, but like in a lot of cases, people are slow to act on a recommendation,” Dodaro told committee lawmakers. “That’s why we keep following up.”

Addressing the FEHB spending challenges will involve a multi-pronged approach from OPM. It’s a matter of finding and removing currently enrolled ineligible FEHB members and preventing new members from enrolling in error, while also making long-term data updates to more easily root out ineligible enrollees in the future.

OPM is already gearing up to take some of these steps beginning in 2025. Starting next year, federal employees will be required to provide eligibility documentation for any family members they want to add to their insurance coverage during Open Season. But on top of that, Dodaro said an audit of current FEHB enrollees is necessary.

“[OPM] has not yet gone back and looked at all the people that are already in the system as to whether they have legitimate numbers of … people who are eligible for services,” Dodaro said. “They could sample across federal agencies, they could get some participation. But there has to be a thorough audit done of existing people that are on the federal employee’s health benefit systems.”

OPM is planning to start on this path as well. During this year’s Open Season, agencies will be required to validate the eligibility of a random sample of FEHB participants. That sample must comprise at least 10% of elections for both Self-Plus-One and Self-and-Family enrollments. Where possible, OPM is also encouraging agencies to validate larger portions of enrollees. If agencies find ineligible members through that data collection, they’ll have to follow OPM’s instructions for removing them.

A centralized FEHB database

But another major barrier for OPM to make improvements, Dodaro said, is the agency’s lack of a central database of FEHB enrollees. Without a centralized system, it’s much more difficult to identify and remove erroneously enrolled FEHB participants.

“Current FEHB eligibility determination and enrollment is highly decentralized and requires cooperation between nearly 100 employing offices responsible for determining eligibility and enrolling more than 8 million members,” OPM said in April. “If funded, OPM could extend this same central enrollment system to all FEHB enrollments, which would allow OPM to manage and make consistent all FEHB enrollments and remove individuals who cease to be eligible for the program.”

OPM, as part of its fiscal 2025 budget request, is proposing legislation to build a centralized enrollment system for FEHB. With a central database, OPM would be able to more quickly address the problem and avoid the spending errors. That system, if it’s implemented, would be modeled after the centralized system OPM just recently built for the upcoming Postal Service Health Benefits program.

During the oversight committee hearing, Dodaro said OPM Acting Director Rob Shriver’s background in insurance should help OPM make headway and get the changes underway — as would asking the Office of Management and Budget for additional support.

“He knows what the shortcomings are,” Dodaro, speaking about Shriver, told House committee members last week. “The question he’s wrestling with is how can he implement all these things that need to be implemented as soon as possible, like getting a central repository in place.”

The post Centralized FEHB database key to OPM cost savings, GAO says first appeared on Federal News Network.

For federal employees, a bill pending in the Senate would bring expanded coverage of fertility treatments through the Federal Employees Health Benefits (FEHB) program.

But the Right to IVF Act, which Sens. Tammy Duckworth (D-Ill.), Patty Murray (D-Wash.) and Cory Booker (D-N.J.) introduced last week, did not garner the 60 votes needed to move forward with a floor vote Thursday afternoon. Almost all Republicans voted against the measure to advance the legislation, resulting in a 48-47 tally.

The legislation rolls together three previous bills all aiming to improve access and insurance coverage for in-vitro fertilization (IVF). In part, the bill would have impacts specifically on FEHB enrollees. One component of the Right to IVF Act aims to set higher requirements for FEHB carriers to offer IVF coverage.

The Office of Personnel Management increased FEHB carrier requirements for IVF treatments for plan year 2024. But the legislation looks to further extend the requirements of IVF to cover both treatments and medications, as well as expanding to more types of assisted reproductive technology (ART).

The Democrat-led bill currently has 48 cosponsors. Generally, it focuses on establishing broader access to IVF and ART and lowering treatment costs, which without insurance can add up to tens of thousands of dollars in costs.

“Federal workers — myself included — know how expensive paying for IVF out of pocket can be, and the cost has put it out of reach for far too many,” Stacey Young, president of the Department of Justice Gender Equality Network (DOJ GEN), a federal employee advocacy group, told Federal News Network.

The push for a vote on the IVF bill represents a mindset shift toward the presidential campaign now just five months away, the Associated Press reported. Duckworth and other co-sponsors of the bill have said the legislation is also a response to the overturning of Roe v. Wade in 2022, and other more recent efforts to limit access to fertility treatments and medications.

“Today, women and families … are worried about what comes next, including the erosion of reproductive freedoms nobody thought were at risk. This includes access to services like IVF,” Senate Majority Leader Chuck Schumer (D-N.Y.) said Tuesday on the Senate floor. “The Right to IVF Act establishes a nationwide right to IVF and eliminates barriers for the millions of families looking to use IVF to start and grow a family.”

The Biden administration also came out in support of the legislation and called for its passage.

“The administration looks forward to working with Congress … in order to protect access to fertility services, eliminate barriers for families in need of high-quality, affordable fertility services, and ensure that federal agencies have the resources to implement these benefits,” the Office of Management and Budget wrote in a statement of administrative policy Wednesday.

DOJ GEN has continually called for better federal health care coverage of infertility treatments. The group is one of many stakeholders that pushed for the advancement of the Right to IVF Act in the Senate.

“Supporting this bill should be a no-brainer,” Young told Federal News Network. “Our nation’s public servants should have affordable access to the full range of reproductive health care, including IVF and other forms of assisted reproductive technology.”

But some lawmakers, along with DOJ GEN, have said even without the legislation, OPM should still work to add more coverage for FEHB enrollees. For plan year 2024, OPM already expanded IVF coverage requirements for FEHB carriers to provide, at a minimum, coverage of the cost of drugs related to an IVF procedure for three cycles annually. OPM has also encouraged FEHB carriers to go beyond the minimum requirements — and so far, 24 carriers have done so.

DOJ GEN leaders said they’re grateful for the efforts OPM has made so far in the FEHB requirements. But the advocacy group wants OPM now to take things a step further. DOJ GEN is asking OPM to expand health carrier requirements to cover IVF treatments, on top of medications, for plan year 2025.

“OPM has the opportunity to break new ground again in 2025 by mandating not only coverage of IVF medications, but also medical treatments,” DOJ GEN wrote in a letter to OPM Acting Director Rob Shriver in May. “Medical treatments comprise the lion’s share of the cost of IVF. Many of our members can attest first-hand to the financial strains that paying out of pocket for IVF placed on them. Some had to drain their savings; borrow money from family members; or forgo treatments entirely. Others left DOJ for private-sector jobs that offered full IVF coverage, taking their invaluable skills and institutional knowledge with them.”

OPM declined to comment on whether there were any plans underway to further expand coverage requirements for IVF in the health insurance program. But some federal health experts have said with just a few months before Open Season, it’s likely too late to expand the coverage as early as plan year 2025 — though it would be possible in future health plan years.

Betsy Campbell, chief engagement officer at national infertility association RESOLVE, said the calls for better insurance coverage of fertility treatments have been growing.

“We know that hundreds of federal employees have been reaching out to OPM to request this coverage, and we’ve started to see some progress with OPM,” Campbell said in an interview with Federal News Network. “The next step is actually adding the medical procedure of IVF. So we’re hopeful that OPM will listen to their employees and add this highly desired benefit.”

RESOLVE has also been encouraging the adoption of a more inclusive definition of infertility that would help LGBTQ+ employees as well as unpartnered individuals access IVF and other fertility benefits through FEHB — but she said the efforts should go beyond simply updating the definition.

“There appears to still be some work, because donor sperm and donor eggs aren’t necessarily covered by all the plans,” Campbell said. “And that, of course, is needed by same-sex couples and non-partnered people when building their families. It’s one thing to have an inclusive definition, but you also have to cover the elements that are needed for these communities to build their families as well.”

A 2021 survey from Mercer, in partnership with RESOLVE, found that a vast majority of employers that increased fertility treatment coverage and benefits did not see a significant increase in medical plan costs.

Additionally, Campbell said, these types of benefit adjustments can significantly impact recruitment and retention of employees.

“You don’t want to provide yet another reason for them to leave federal employment to go to a private employer that is providing fertility benefits,” Campbell said. “Often employers don’t realize there’s a gap in this coverage until it’s pointed out. I think we’re seeing OPM trying to fill this gap piece by piece … Now it’s time to also cover these medically necessary procedures to help their employees build their families.”

The post Senate GOP blocks bill to expand IVF access as advocates call for better FEHB coverage first appeared on Federal News Network.

OPM’s inspector general office shared more information about the pause on Thursday, saying it comes “out of an abundance of caution,” and to try to prevent further fraud, the OIG said in a special fraud alert.

In addition to new enrollments, the enrollment pause also applies to any current enrollee in FSAFEDS who experiences a qualifying life event (QLE), such as a marriage or the birth of a child.

During the pause, current FSAFEDS enrollees are still able to make reimbursement claims. Once OPM chooses to resume the enrollment functionality, FSAFEDS will retroactively adjust any elections based on QLEs. But currently, OPM has not set a date for when the functionality will resume.

The pause comes after several hundred federal employees currently enrolled in FSAFEDS experienced recent fraudulent activity on their accounts. Scammers have used the employees’ personal information to either create new, fraudulent FSAs, or otherwise make fraudulent reimbursement claims on existing FSAs.

HealthEquity, the vendor that administers FSAFEDS, previously notified OPM of the recent rise in fraudulent activity.

“OPM is working with the vendor to secure impacted accounts, compensate impacted individuals and implement additional anti-fraud controls,” an OPM spokesperson said in an email statement.

The fraudulent activity in FSAFEDS is relatively limited in scope, since it’s affecting just a few hundred federal employees’ accounts. In total, the scammers have managed to shore up a couple hundred thousand dollars, Politico first reported last week.

Since becoming aware of the fraud, HealthEquity has already taken additional security measures by implementing Login.gov requirements and setting up dual-factor authentication for federal employees to be able to log in to their FSAFEDS accounts.

A HealthEquity spokesperson declined to comment with any additional details on the current status of the affected FSAFEDS accounts, or if there would be further changes to security protocols.

There’s currently no evidence that the fraudulent activity is coming from a compromise in either OPM’s or HealthEquity’s online systems, but the investigation into the source of the fraud is ongoing.

In the meantime, the accounts of any affected individuals have been secured, and OPM is in the process of reimbursing all impacted enrollees in full.

Agency benefits officers and payroll providers are advising federal employees who use FSAFEDS to review and verify their leave, earnings and FSA account statements. If employees notice any suspicious charges or activity, they can call FSAFEDS at 877-372-3337.

Each year during Open Season, federal employees have the option to enroll in FSAFEDS, but as of last plan year, less than 20% of eligible feds actually have an account set up in the health program.

FSAFEDS lets current federal employees set aside pre-tax dollars from their paychecks to go toward covering eligible health care, prescription, dental, vision and child and adult day care expenses. Enrollees will usually pay for the medical costs out of pocket and are then reimbursed using funds from an FSA.

For 2024, employees who are enrolled in an FSA can contribute up to $3,200 for the entire year. The funding has to be used within a given plan year, but there is an option to roll over up to $640 to the following year. Many federal health experts highly recommend opening and contributing to an FSA, as it lets participants save money by contributing to health expenses pre-tax.

The overall eligibility pool for FSAFEDS has also recently expanded. Beginning in January, for plan year 2024, OPM made active-duty service members as well as members of the Active Guard Reserve eligible to start a Dependent Care Flexible Spending Account (DCFSA). The program expansion made about 400,000 active-duty service members newly eligible for the benefits of FSAs.

The post OPM pauses new FSAFEDS enrollments after fraud surge first appeared on Federal News Network.

More than 175 House and Senate Democrats are urging the Office of Personnel Management to require every FEHB carrier to expand their offerings and cover costs for both infertility treatments and medications, starting in plan year 2025.

That requirement “would reflect the reality that IVF is one of the most effective treatments for families struggling with infertility, and growing in popularity, with its usage nearly doubling from 2012 to 2021,” the lawmakers, led by Rep. Gerry Connolly (D-Va.) and Sen Tammy Duckworth (D-Ill.), wrote in a letter to OPM Tuesday.

Starting just this year, FEHB carriers already began covering, at a minimum, two forms of artificial insemination and associated drugs, as well as the costs of IVF-related medications for at least three cycles of treatments. The requirements for carriers cover the cost of medications, but not necessarily the cost of the IVF treatment itself.

OPM did not note any plans to increase infertility treatment coverage for 2025 in its most recent call letter to carriers from February. But Kevin Moss, marketing director at Consumers’ Checkbook, said that’s not necessarily surprising. OPM is running up against the clock for FEHB negotiations ahead of plan year 2025.

“I would be surprised to see a change this big happening this late for a new plan year,” Moss said.

There are only a few months left before benefits are locked in with the federal insurance program’s carriers. FEHB health plans have to submit their rates and benefits for the 2025 plan year by May 31. From there, OPM will negotiate and finalize benefit negotiations by July 31 for the upcoming plan year.

During that process, an OPM spokesperson said the agency will work with carriers to promote expanded access to comprehensive IVF services. In particular, OPM is strongly encouraging carriers to offer more comprehensive IVF coverage, beyond the minimum required level.

“OPM expects carriers to provide quality options for gender-affirming care and services, maternal health, fertility, obesity management, mental health and substance use disorder treatment, and telehealth benefits” the agency wrote in its February call letter.

In their letter, lawmakers expressed appreciation for the steps OPM has already taken to broaden infertility treatment coverage in FEHB by offering some coverage of related medications. It’s a significant change, considering that IVF treatments can cost tens of thousands of dollars out of pocket for just one cycle — and 35% of that price tag comes from prescription drug costs, the lawmakers said.

But the lawmakers said offering further benefits would help agencies better compete for employees, who may seek different job opportunities with better insurance coverage elsewhere.

“While significant work remains to be done to improve IVF access, which includes ensuring comprehensive plan designs are inclusive of LGBTQ and solo individuals who rely on medical intervention to build their families, your leadership in making sure FEHB plans cover IVF medications represents meaningful progress in expanding access to fertility treatments, which will ultimately prove life-changing for families across the country,” the lawmakers said in their letter to OPM Director Kiran Ahuja.

An OPM spokesperson said that 24 plans are currently covering a greater portion of the IVF procedure, beyond the drug costs and above the minimum requirements in FEHB. For instance, Blue Cross Blue Shield Association is covering up to $25,000 per year in IVF costs.

Still, the current coverages available through FEHB may leave room for improvement.

“There is some coverage in some of the plans, but it is fairly limited and leaves couples with a lot of out-of-pocket expenses,” Tammy Flanagan, a federal benefits and retirement specialist at Retire Federal, told Federal News Network. “We will see how much this is expanded later this year when the plans announce their benefit changes for 2025.”

Regardless, it’s important for enrollees to carefully review all available information when selecting a plan during Open Season, the OPM spokesperson said.

OPM is also ramping up preparations for the launch of the Postal Service Health Benefits (PSHB) program next year. The program will cover about 2 million Postal Service employees, annuitants and their family members. In March, OPM conditionally approved 32 carrier options for PSHB in 2025.

This year, Open Season will run from Nov. 11 to Dec. 9. During that time, both FEHB and PSHB enrollees can make elections and changes to their health care options for plan year 2025.

The post Lawmakers urging expanded IVF coverage for FEHB enrollees first appeared on Federal News Network.

Starting in Open Season this fall, agencies will be required to validate participant eligibility of a random sample comprising at least 10% of FEHB elections for both Self-Plus-One and Self-and-Family enrollments.

OPM noted that 10% is the minimum for validation, and is encouraging agencies to validate larger portions of enrollees when possible. Agencies have to report their enrollment reviews to OPM by July 2025. If agencies find ineligible members through the sample collection, they’ll also have to follow instructions for promptly removing them, OPM said in a benefits administration letter Wednesday.

“Today’s actions build on years of progress addressing issues in FEHB enrollments,” OPM said. “Collectively, these requirements ensure that agencies are verifying documentation provided during each of the key periods when an employee might make a change.”

The new requirements for agencies come after a 2022 Government Accountability Office report found that OPM may be spending up to $1 billion each year on ineligible enrollees in the governmentwide health insurance program, which covers 8 million participants.

“The longer OPM delays its efforts to establish a monitoring mechanism to identify and remove ineligible program members, the more ineligible members and related improper payments in the program may continue to accrue, costing the program millions, or up to approximately one billion dollars per year, according to OPM’s own estimate,” GAO said in the 2022 report.

Beginning in 2025, federal employees will also be required to provide eligibility documentation for any family members they want to add to their insurance coverage during Open Season.

Identifying ineligible dependents has remained a top challenge for FEHB since 2018. In 2021, OPM first put regulations in place to monitor family member eligibility during a member’s initial enrollment, or during qualifying life events. Before 2021, OPM was not asking FEHB enrollees for any verification of family members’ eligibility for health insurance coverage, and instead only using “self-certification.”

OPM’s new requirements, announced this week, now mark even stricter requirements, now verifying family members who get added to FEHB elections during Open Season, the time of year when many participants are actually adding new individuals to their plans.

OPM also just recently completed an FEHB “Master Enrollment Index” that’s meant to root out any irregularities in existing FEHB enrollments. OPM said it will then further review any irregularities that the index finds, and keep agencies informed of those reviews.

The challenges in FEHB eligibility verification have gained attention in Congress as well. The FEHB Protection Act, which Sens. Rick Scott (R-Fla.) and Tom Carper (D-Del.) introduced in March, would similarly require OPM to verify eligibility before adding new members to the health care program. If enacted, the bill would also require an audit of FEHB to remove any invalid members who are currently enrolled.

“By confirming eligibility, we have the potential to save taxpayers hundreds of millions of dollars annually,” Carper said about the bill. “I look forward to working with my colleagues and OPM to ensure they have the resources and tools needed to end improper payments and root out fraud in the FEHB.”

As part of its fiscal 2025 budget request, OPM is also proposing legislation to build a centralized enrollment system for FEHB — which could help relieve some of the challenges of ineligible members in the system. That system would be modeled after the centralized system OPM has just recently built for the upcoming Postal Service Health Benefits program.

“Current FEHB eligibility determination and enrollment is highly decentralized and requires cooperation between nearly 100 employing offices responsible for determining eligibility and enrolling more than 8 million members,” OPM said. “If funded, OPM could extend this same central enrollment system to all FEHB enrollments, which would allow OPM to manage and make consistent all FEHB enrollments and remove individuals who cease to be eligible for the program.”

The post Stricter FEHB requirements from OPM aim to root out ineligible members first appeared on Federal News Network.

• Open Season is not until this fall, but some feds may want to start looking at their health care early. A special enrollment period starts today for Postal Service annuitants. USPS retirees who are eligible for Medicare Part B, but do not have it, can sign up between now and September 1 without having to pay a penalty. The USPS is covering the cost of the penalty for any annuitants who do choose to sign up. The special enrollment period comes ahead of the launch of the brand-new Postal Service Health Benefits program for plan year 2025. And for everyone else, Open Season will run Nov. 11 to Dec. 9.
  (Postal Service Health Benefits program - Office of Personnel Management)
• Nearly a two-year effort has concluded with agencies receiving their first update to the standards for collecting federal data on race and ethnicity in more than 25 years. The Office of Management and Budget's Chief Statistician Karin Orvis said the interagency working group made several significant changes to the standards, including adding Middle Eastern or North African as a new minimum category. Agencies are to begin updating their surveys and administrative forms as quickly as possible and must submit an agency action plan for complete compliance within 18 months. Orvis said the working group reviewed 20,000 comments and held almost 100 listening sessions as part of its effort to finalize the new standards.
  (OMB updates standards to collect federal data on race, ethnicity - White House)
• The Defense Department has established the Office of the Assistant Secretary of Defense for Cyber Policy. The new office, officially launched on March 20, will oversee all cyber-related policy issues at the Pentagon. That includes certifying the department's cyber operations budget and overlooking cyber workforce development programs. Ashley Manning will serve as the official performing the duties of the assistant secretary until the Senate confirms an official for the position. President Joe Biden nominated Michael Sulmeyer, who is currently serving as the principal cyber adviser to the Army Secretary, to serve in the new role.
  (Establishment of the Office of the Assistant Secretary of Defense for Cyber Policy - DoD)
• There is a new section to the FAR and it may be the most important change in decades. Get used to hearing about FAR Part 40. It's the new consolidated section of the Federal Acquisition Regulations for all things cybersecurity and supply chain security. The FAR Council issued the final rule today establishing this new section, bringing together clauses and regulations covering broad security requirements for most acquisitions. The new FAR part will provide contracting officers with a single, consolidated location to find these requirements. While the new FAR section does not create any new requirements or contract clauses, the council currently is reviewing three rules that would be added to Part 40 when finalized.
  (FAR Council formally established new cybersecurity section - Federal Register)
• Senate lawmakers are pushing to bring federal record-keeping practices into the 21st century. Agencies would need to make sure employees back up their texts and other digital chats used for official business under the Strengthening Federal Records Act of 2024. Sens. Gary Peters (D-Mich.) and John Cornyn (R-Texas) are co-sponsoring the bill. They say the Federal Records Act needs to keep with rapidly changing technology. The bill would also strengthen the role of the National Archives and Records Administration in holding agencies accountable to record-keeping rules.
  (Senate bill aims to bring federal records law into the age of ‘WhatsApp’ - Federal News Network)
• The Navy has created a sort of one-stop-shop of efficiency when it comes to Navy Culture. A new initiative dubbed Culture of Excellence 2.0 aligns several Navy programs and concepts, allowing the leadership to better understand the needs of its sailors. New materials released as part of the initiative include a playbook on mental health and a suicide-related behavior response guide. The women’s initiatives team and the new policy for the assignment of pregnant sailors also fall under the umbrella of Culture of Excellence 2.0. And there will be a new tool for commanders to better understand the risk of destructive behaviors within their commands.
  (Navy updates its culture campaign - U.S. Navy)
• A new leader has taken the reins at the National Security Agency’s Cybersecurity Directorate (CSD). Dave Luber formally took over as CSD Director on Friday, replacing Rob Joyce, who had led the directorate since 2021. Luber previously served as CSD’s deputy director. He is a longtime veteran of the intelligence community, having also served as executive director at U.S. Cyber Command and in various positions throughout the NSA. The Cybersecurity Directorate is responsible for helping to secure defense industrial base networks and issuing public advisories on cyber threats.
  (New NSA CSD director - X)
• When candidates go online to apply for a federal job, they will see a brand new look. USA jobs.gov has updated its homepage design and some key features of the website. There is now a "search tips" option for anyone who might need help narrowing down a search. A link at the top of the homepage will take users to a list of upcoming hiring events and information sessions. And there is info about what career fields are hiring right now, and how the federal hiring process works.
  (Website homepage update - USAJobs.gov)

The post Medicare Part B special enrollment period for USPS annuitants begins today first appeared on Federal News Network.

Join us for Federal News Network’s 2024 Open Season Exchange on Nov. 12. During this exclusive event, Federal News Network reporters and editors will sit down with agency and industry experts to share details about what to consider when making your 2025 FEHB selections during Open Season.

Our 2023 Open Season Exchange event featured speakers from the Office of Personnel Management, Defense Health Agency and Consumers’ Checkbook.

Register today to save the date on your calendar and receive updates!

The post Federal News Network’s Open Season Exchange 2024 first appeared on Federal News Network.

Starting in January 2025, about 1.9 million USPS employees, annuitants and their families are expected to be enrolled in a health plan within the upcoming Postal Service Health Benefits (PSHB) program.

Ahead of the new plan year, Postal employees and annuitants are getting a better idea of what options will be available to them. For 2025, Postal Service employees and annuitants will tentatively be able to select from 32 different carrier options.

OPM approved the couple dozen options this week — but their finalization is still contingent on upcoming negotiations of the specific benefits and rates each carrier will offer.

Similar to the FEHB options, offerings in the new PSHB will mostly be health maintenance organization (HMO) plans, with a couple fee-for-service plans mixed in as well. HMO plans use an existing network of medical providers and coordinate services for enrollees. Fee-for-service plans are more traditional — the carrier will either pay a medical provider directly, or reimburse an individual who has paid a provider and then filed an insurance claim.

Some PSHB plans will be specific to geographic areas, while others will be available to USPS employees and annuitants nationwide.

2025 PSHB carrier options

Information courtesy of the Office of Personnel Management. Chart created by Federal News Network.

The new health care program for USPS is a requirement stemming from the 2022 Postal Service Reform Act. The law mandated OPM to set up a health insurance program specifically for USPS with a tight timeline of launching in January 2025.

“I want to thank the carriers for their interest in supporting the health care needs of our federal workforce,” OPM Director Kiran Ahuja said in a statement. “This program improvement is only possible thanks to carrier participation and the tireless work of USPS and our OPM team.”

Postal employees and annuitants will have the opportunity to enroll in PSHB for the first time ever during the upcoming Open Season this November and December, OPM said. This year’s Open Season will offer both PSHB and FEHB enrollees the chance to adjust their health care options for the 2025 plan year.

In most cases, Postal employees and annuitants will be able to pick a health plan that’s comparable to their current plan in the FEHB. In cases where there isn’t an equivalent option available, OPM will automatically enroll individuals into the cheapest, no-fee, non-high-deductible plan that’s available in PSHB.

Ahead of implementation, certain Postal employees and annuitants will also be able to enroll in Medicare Part B during a special enrollment period between April 1 and September 1.

Additionally, for Postal annuitants, OPM will be requiring PSHB carriers to provide prescription drug coverage through Medicare Part D. Because of the upcoming requirement, it’s likely that most FEHB carriers will also offer Part D prescription drug coverage in 2025 as well.

Of course, launching such a large program comes with a price tag too. OPM initially received $70.5 million in appropriated funding to go toward the start-up costs for the PSHB program.

Now, for fiscal 2025, OPM is seeking another $24 million in funding for administering and maintaining the PSHB program over the next year.

“OPM is taking an enterprise approach to delivering this ambitious and modernized approach to providing health benefits under extremely tight deadlines,” OPM said in its 2025 congressional budget justification. “In addition to bringing together program offices across the agency, OPM is working collaboratively with USPS on communicating to employees about the changes and partnering with agencies across government to provide the necessary data integration to determine eligibility.”

OPM said solid funding for the agency’s inspector general office is also crucial to effective oversight of the new program — with the goal of ensuring it’s secure, effective and efficient. OPM is requesting $2.6 million for oversight of the PSHB program for 2025.

“The PSHB program risks annual losses of millions of taxpayer dollars due to fraud, waste or abuse as the program begins enrollment and disbursing benefits,” OPM said. “It faces similar risks as the FEHB program of health care fraud schemes and improper payments.”

A 2023 report from the Government Accountability Office showed that OPM spends up to $1 billion each year on ineligible enrollees in FEHB.

OPM said it is planning to use the PSHB’s launch as a litmus test for possible changes to the FEHB program moving forward. It’ll be especially important as the agency works on ways to better identify and remove ineligible members from the program.

This year’s Open Season will run from Nov. 11 to Dec. 9. During that time, both FEHB as well as new PSHB enrollees can view and make changes to their health care options for plan year 2025.

The post USPS health care program will have 32 carrier options in 2025 first appeared on Federal News Network.

In preparation for the 2025 plan year, OPM for the first time outlined clearer plans to implement the Postal Service Health Benefits (PSHB) program in January.

For years, OPM’s annual call letter to carriers has focused solely on setting the stage for the upcoming FEHB plan year. But OPM’s latest letter details the implementation of PSHB, the new health insurance program for the roughly 1.2 million Postal Service employees, annuitants and their families.

A special enrollment period beginning April 1 as well as the upcoming Open Season this fall will be the first time Postal employees and annuitants will be able to enroll in the brand-new health insurance program, mandated by the Postal Service Reform Act that President Joe Biden signed into law in 2022.

Any FEHB carrier that wants to apply to offer plans in the PSHB program must submit their proposal of benefits and rates by May 31, OPM said. Then enrollees in the new PSHB program will begin receiving coverage on the first day of 2025.

“OPM welcomes all PSHB carrier applicants and looks forward to launching this new program with you,” OPM Associate Director for Healthcare and Insurance Laurie Bodenheimer said in the Feb. 8 call letter.

More details about PSHB program

OPM’s February call letter gives more indication of how the PSHB program and enrollment window for Postal employees and annuitants will work. But there may be even more changes in the coming months.

One major difference for feds in plan year 2025 once again deals with Medicare Part D — the section of Medicare that provides prescription drug coverage. Part D already saw significant uptake within FEHB this year. For 2024, 17 FEHB plans offered a Part D plan.

But starting in 2025, that number could become much bigger.

That’s because any FEHB carrier that offers a PSHB plan has to provide prescription drug coverage through Part D for Postal annuitants who have Medicare, said Kevin Moss, editor of the Consumers’ Checkbook Guide to Health Plans for Federal Employees.

“This is how Postal annuitants will actually receive their prescription drug coverage,” Moss said in an interview. “And every PSHB plan will have to have a Part D plan in order to provide that prescription drug coverage.”

Moss said he expects that because of the new Medicare Part D requirement, almost every FEHB plan will likely have Part D prescription drug coverage available to annuitants for 2025, mirroring the setup for PSHB.

That’s highly important for both FEHB participants and future PSHB enrollees to consider since those with Medicare will be auto-enrolled into a Part D plan. OPM lets FEHB carriers to auto-enroll their Medicare members in a Part D plan as long as there’s an easy way to opt out.

In most cases, Medicare Part D enrollment will be beneficial to FEHB and PSHB participants. But there are certain scenarios, Moss said, where annuitants should keep a close eye on the changes.

Enrollees who have weight loss drug prescriptions, for example, may see some limitations under a Medicare Part D plan.

Every FEHB plan has to cover at least one type of GLP-1 weight loss drugs, which are often used to treat Type 2 diabetes. But by law, Medicare does not provide coverage of those drugs, which can cost $15,000 — sometimes even more — out of pocket.

Annuitants who get auto-enrolled into a Part D plan may lose coverage of weight loss drugs they initially had under their FEHB plan.

“That’s a very strong reason for you to opt out,” Moss said. “Federal annuitants will need to do their homework this fall to see how Part D will impact them and to determine if they’ll be better off with Part D or FEHB prescription drug coverage.”

Another part of the Postal Service Reform Act requires the PSHB program to offer the same benefits between comparable FEHB and PSHB plans. Even though the benefits will be the same, the cost to the enrollee will likely differ.

“The rates are going to be different because the Postal Service employees and annuitants are going to be a new coverage entity, separate from all other federal employees and annuitants,” Moss said. “We don’t yet know what impact that will be. We do expect that those rates will be different, but we don’t know if they are going to be higher or lower.”

But the number of plan options will likely be smaller, Moss added, because of certain requirements for carriers. Any health plan for the government has to have a minimum of 1,500 “covered lives,” which could impact what types of plans will be available in the PSHB based on population size.

Fertility coverage, member eligibility, other priorities

In its call letter, OPM additionally emphasized that carriers should continue to prioritize coverage of gender affirming care and services, maternal health, fertility, obesity management, mental health and substance use disorder treatment, as well as telehealth benefits, into 2025 and beyond.

OPM has prioritized those areas of coverage for at least the last few years. FEHB saw changes for the 2024 plan year, for instance, with new requirements for health carriers to provide coverage of certain infertility treatments.

Now, OPM is also looking at ways to reduce and prevent misuse of opioids, Moss said.

Additionally, OPM’s call letter referenced plans aiming to improve the way FEHB tracks member eligibility in the program. That comes after the Government Accountability Office reported in 2023 that OPM may be spending up to $1 billion annually on ineligible FEHB participants. GAO said OPM does not currently have a clear way to identify and remove FEHB enrollees’ family members who are erroneously part of the program.

In the new call letter, Bodenheimer said carriers are responsible for tracking and preventing fraud, waste and abuse in the program — including rooting out ineligible members.

“Carriers and employing offices share the responsibility to ensure family member eligibility, recognizing that coverage of ineligible family members can lead to improper payments, including erroneous or fraudulent claims,” Bodenheimer said.

Carriers have to verify eligible family members when FEHB participants add new members to their plans, Bodenheimer said.

Using lessons learned for the future FEHB

The upcoming PSHB enrollment period and plan year for 2025 will have major ripple effects on the government’s health care programs on the whole. OPM Deputy Director Rob Shriver said the new central enrollment platform OPM created for PSHB will eventually serve as a template to potentially restructure the FEHB program.

“We’re building that system to be a model for FEHB modernization over the long term,” Shriver said in an interview with Federal News Network in January. “We’ve been working with stakeholders across the government, with the health plans, with Postal employees, to design this system in a way that takes advantage of the advances in technology. It will both improve the customer service experience for Postal workers and their families, and also will allow for more efficient and effective administration of the program. This is really a great opportunity for us to roll out a new system that’s built the right way for this population and for this purpose.”

To try to get ahead of potential pitfalls in launching such a massive program, Shriver said OPM is planning to roll out a “robust decision support tool.” The tool is meant to help Postal employees evaluate their health plan options and make the most informed health care insurance decisions based on their health needs.

“We’ll have a robust customer service program in place to handle a large influx of questions,” Shriver said. “It’s a new approach. People are going to have questions and we want to make sure we’re ready to handle those.”

The post OPM tells FEHB carriers to prepare for USPS health program’s launch first appeared on Federal News Network.

I never saw one of these impressive cars, dubbed the Cullinan, until a couple of weeks ago. Spotted not in Beverly Hills, Scarsdale, New York or Great Falls, Virginia, but rather on the streets of Da Nang, Vietnam. Oddly, in 12 days of vacationing in that remarkable country, I saw more Rolls Royces than I’ve seen in a year here in the U.S. Even the national legacy of no less than Ho Chi Minh has its 1%.

Knowing Open Season for the Federal Employee Health Benefits Program was occurring, I asked a couple of local Vietnamese how they experienced health care in the relatively poor but fast-growing nation. They all said, essentially, “It’s great if you have money.”

In some ways that’s true everywhere. Nations from Vietnam to Great Britain have public (also called social) health care plans alongside private plans for those who can afford. Of course, you can find Rolls Royce-driving people everywhere, who can simply pay their own way. But few places, and certainly no private employers, offer the range of health care insurance plan options to which federal employees can pick from.

The U.S. healthcare and healthcare insurance system can be expensive, frustrating and ineffective at its worst. At its best, it provides one more incentive for millions to try and get into the U.S. And, just as the Thrift Savings Plan stands as a model for 401K-type plans, the FEHBP program might be about the best health-related benefit you’ll find anywhere. As someone with a pretty darn good union-provided plan, I’m jealous!

Anecdote: A close friend and neighbor, a longtime attorney in a federal agency, came down suddenly with a life-threatening illness a week ago. Within a day or two he’d secured appointments with specialists at elite healthcare delivery organizations in the D.C. region. No one can escape one’s maker’s ultimate plan, but under the FEHBP you’ve got better odds than most of the people on Earth, including those who, to this day, crouch in the rice paddies of Southeast Asia.

That’s why I’d like to urge you, between now and Monday, when Open Season concludes, to do the research necessary to make sure you have the best plan at the best price for you and, if applicable, your dependents. I say this because of the single-digit percentage of employees who actually do switch in a given year.

Yes, premiums are up this year by nearly 8% on average, after rising nearly 9% last year. Increases don’t occur across the board, though. At least one plan is down by 50%, according to Kevin Moss, the editor of the Consumers Checkbook Guide to Health Plans for Federal Employees. He spoke at the recent Federal News Network Open Season Exchange.

Besides replacing what you have for less money, Moss said switching from, say, self-plus-one to each of a couple having single plans can also save money.

“It may be that one plan works better for one spouse, and another plan works better for another spouse,” he said. Just be sure to take the deductibles into account when making the calculus.

As the Office of Personnel Management noted, the number of choices of plans fell for 2024. But the numbers— 271 plans down to 156 — look more dramatic than the reality. Which is, Humana and a few smaller providers pulled their HMO (health maintenance organization) plans from the federal market, Moss said. People that were in those plans have to choose. Otherwise OPM will put you in the lowest-cost national PPO (preferred provider organization) plan, GEHA Elevate. That’s a fine plan. You have other options, but you’ve got to do a little homework. As Moss put it, you want to maintain control over your choice of healthcare insurance provider.

Another thing to keep in mind:  A plan you might have liked wasn’t offered in your area. Check again. It may have spread. For example, Moss pointed to a Kaiser Permanente plan in Colorado that added two counties for next year. Sentara Health expanded from Newport News, Virginia to Northern Virginia. Moreover, you might be able to choose new options from existing offerors. For example, Moss said, Compass Rose will offer a new standard plan.

You get the idea. Among our Exchange, the Consumer’s Checkbook Guide and the materials from OPM, there’s plenty of information out there. Use it to make a good thing better.

Nearly Useless Factoid

By: Daisy Thornton

One of the most expensive coffees in the world originated in Vietnam. Kopi Luwak, also known as weasel coffee, can cost up to $3,500/kg. It’s so expensive because the process is labor intensive: The coffee cherries are actually eaten and partially digested by an Asian palm civet, a type of weasel. The cherries are partially fermented during the digestion process, changing their flavor. Farmers then gather the beans from the feces, clean them, and continue the roasting process.

Source: Culture Trip

The post Do your health care homework this weekend! first appeared on Federal News Network.

Ahead of a new year of health care, federal employees and annuitants have less than a week left to take advantage of Open Season — and possibly make changes to their enrollments.

Enrollees have until 11:59 p.m. on Dec. 11 to make their final selections. If they don’t act, their current plan in the Federal Employees Health Benefits (FEHB) program will automatically roll over into 2024.

Not every enrollee should necessarily make a change to their health, vision and dental plan options. At the very least, it’s wise to learn how your plan will change in 2024, said Kevin Moss, editor of the Consumers’ Checkbook’s Guide to Health Plans for Federal Employees.

“You can’t assume that the plan you had this year will be the exact same plan next year,” Moss told Federal News Network. “You might find new pre-authorization requirements, cost share changes, new benefits or benefits that are no longer available. Also, the in-network status of providers can change any year, as can the coverage status of prescription drugs.”

Information about the coming changes to any plan can be found in section two of a carrier’s official plan brochure as well as on the plan’s website.

The Office of Personnel Management, which runs FEHB and the Federal Employee Dental and Vision Insurance Program (FEDVIP), also offers plenty of tools and information on its website to help enrollees understand their options.

“We really are encouraging our folks to be proactive,” OPM Director Kiran Ahuja said during Federal News Network’s Open Season Exchange. “There’s just lots of information that we want folks to take advantage of so we can increase the participation of going through the review. If your plan is great, that’s good. But we want to see more activity on our website to make sure that folks are taking advantage of those materials.”

“All federal employees should have an FSA”

With another sizeable premium increase of 7.7% on average starting in January, taking advantage of Open Season may be especially important this year.

One option that many federal health experts have recommended to FEHB participants is starting a flexible spending account (FSA). These accounts let enrollees set aside pre-tax dollars to go toward covering eligible health care, prescription, dental, vision and child and adult day care expenses.

FSAs are an option for all federal employees, but only 20% actually use them.

“Most federal employees will be paying more for healthcare next year and should be looking for ways to save,” Moss said. “The FSA is one of those ways. All federal employees should have a flexible spending account.”

It’s important to note that participation in an FSA doesn’t continue automatically. Those who had an FSA for 2023 will need to opt into FSAFEDS again.

And there are certain limitations on these accounts that may require a bit of budgeting. Feds can roll over $640 of unused funds into the next plan year. For 2024, there is a maximum contribution limit of $3,200.

Enrollees can sign up for an FSA on the FSAFEDS website.

The argument for a high deductible health plan

Aside from starting or continuing an FSA, feds can also consider enrolling in a high deductible health plan (HDHP) to hedge against rising premium rates.

“This tax preferred plan type generally has the lowest estimated yearly costs in the Guide to Health Plans,” Moss said. “It also lets you save for current and future health care expenses.”

HDHPs give feds access to a health savings account (HSA), which lets enrollees set aside funds that can be used to cover qualified medical expenses not covered by a health plan.

An HDHP “gives you greater flexibility and discretion over how you use your health care dollars,” OPM said on its website.

This type of plan isn’t right for everyone, though. OPM said in general, HDHPs are beneficial for those with low medical expenses. But each HDHP is somewhat unique. OPM recommends reviewing individual plan brochures before making a final decision.

Be aware of Medicare Part D changes

There are also significant changes coming to FEHB next year that will impact federal annuitants with Medicare.

In 2024, those who are enrolled in any of the 17 FEHB plans that offer Prescription Drug Plans (PDPs) and who are enrolled in Medicare Part A or Medicare Parts A and B will be auto-enrolled into the PDP option. Enrollees will have the choice to un-enroll, if desired.

But in most cases, a PDP will be the best option for annuitants on Medicare, Moss said, since the carriers must provide as good or better coverage than what an annuitant’s current plan offers.

Moss reviewed the specifics of these changes — and some instances where it may not make sense — in a recent interview on Fed Life.

Just a few days left in Open Season

There are a number of changes to coverage for the 2024 plan year, including expanded coverage for infertility treatments, maternal health care, dependent care and more.

“Our team works very hard to find the right balance between providing the comprehensive coverage that our federal employees and their families have learned to expect and appreciate, coupled with the affordability of those plans,” OPM’s Ahuja said. “That is something we constantly strive for in the balance that we see.”

Additionally, the number of plans and options out there may overwhelm some enrollees, but there are a few ways to narrow it down.

For one, enrollees can use OPM’s plan comparison tool to weigh up to four different plan options at once.

Additionally, on the very last page of FEHB plan brochures, participants will find premium tables detailing the per-paycheck costs for self, self-plus-one and family health plans.

These tables also break down the share of costs between the enrollees’ share and the government’s share of the premiums. That can help feds consider the costs and benefits of different options.

Regardless, anyone looking to take part in Open Season has to act soon. The open enrollment period ends Dec. 11.

The post What feds should know before Open Season ends this year first appeared on Federal News Network.

The two main plans eligible for enrollment are TRICARE Prime, which includes the U.S. Family Health Plan, and TRICARE Select. TRICARE Open Season does not apply to its premium plans – TRICARE Young Adult, TRICARE Reserve Select and TRICARE Retired Reserve. TRICARE Open Season also does not apply to those who are eligible for Medicare or those using TRICARE For Life. It also does not apply to active duty service members. These groups do not have to do anything during Open Season.

“Open Season is an opportunity for you to evaluate the health care coverage that your family has and to see if you need to change plans or if you want to stay in the current plan that you’re in,” Zelle Zim, who’s on TRICARE’s policy and programs team, said at a TRICARE event on Wednesday. “You also have the opportunity to enroll in a new plan during TRICARE Open Season.”

For TRICARE Prime, it focuses on using military hospitals and clinics. There will be a primary care manager, who will give referrals and authorizations for other care. Participants must live within a Prime Service Area, which is generally a 40-mile radius from a military hospital or clinic.

Meanwhile, with TRICARE Select, participants can choose their own providers and there is no primary care manager. Participants will get the most affordable care if they stick within the TRICARE authorized network.

There is an enrollment fee for some TRICARE beneficiaries, depending on which group they are in.

Specifically, for TRICARE Prime, there is no fee for active duty service members, active duty family members and transitional survivors. However, TRICARE Prime retirees and their family members have an annual enrollment fee. Those in Group A – members whose sponsor’s initial enlistment or appointment was before Jan. 1, 2018 – the fee is $363 per individual or $726 per family. For Group B – whose sponsor’s initial enlistment or appointment was on or after Jan. 1, 2018 – the cost is $438.96 for an individual or $879 for a family. Generally, in comparison to 2023, some prices have stayed the same, while others have slightly increased.

Meanwhile, for retirees in TRICARE Select, the annual cost for Group A is $177.96 for an individual or $355.92 for a family. For Group B this is $564.96 for an individual or $1,131 for a family.

Both of these plans – TRICARE Prime or Select – have out-of-pocket costs for some participants. TRICARE Prime has no annual deductible. For this plan, active duty service members and their families have no out-of-pocket costs for covered services from a network provider or with a referral or pre-authorization. However, retirees, their family members and all others have co-payments or cost-shares for covered health services from network providers. Under TRICARE Select, after the deductible is met, participants have fixed co-pays for in-network care and cost-shares for out-of-network care.

Family information should be put in the Defense Enrollment Eligibility Reporting System (DEERS) to ensure proper eligibility.

“One thing that’s very important when we talk about our TRICARE eligibility is your sponsor’s status and that sponsor status and your relationship to that sponsor is captured in DEERS,” Zim said. “DEERS is where all of that family information is captured and it’s maintained by your personnel records office. All the information that is in DEERS is what feeds our eligibility information for TRICARE. So, it’s important that you have that information up to date in DEERS. If you have changes in your family, you always want to make sure that’s in DEERS. That way, we can make sure that everyone in your family is eligible for the correct plans.”

Additionally, participants can mix and match plans amongst their family members.

Participants may also be eligible for Federal Benefits Open Season for dental and vision coverage. That Open Season runs through Dec. 11 and coverage would begin on Jan. 1. However, for most of these dental and vision plans, someone would also need to be enrolled in a TRICARE plan.

The post TRICARE Open Season is underway first appeared on Federal News Network.

If you want a reliable source of accurate information, turn to an encyclopedia. For information on the upcoming year’s Federal Employee Health Benefits Plan options, we found a human encyclopedia: Kevin Moss, editor of the Consumers’ Checkbook Guide to Health Plans for Federal Employees 2024.

During Federal News Network’s 2024 Open Season Exchange, Moss detailed what working and retired federal employees can expect as this year’s open season gets underway.

First off, Moss said, don’t pay attention to threats of a lapse in appropriations or the concerns about possible government shutdowns. Open season and health insurance itself will continue irrespective of what happens on the political front.

The FEHB process “will all happen as it normally does,” he said. “Make sure you go through your agency and follow your agency’s instructions in terms of signing up for your health plan. And worst case scenario, even if there is an interruption, you would just keep your same health plan next year. That’s how FEHB works.”

Moss detailed how premiums will change next year. On average, they’ll rise 7.7%, a solid jump, but at least lower than last year’s average rise of 8.7%.

How come?

“When the Office of Personnel Management was talking about these premium increases, they were referencing higher prescription drug usage and higher outpatient care as reasons why these premiums went up,” Moss said. He said private industry health care insurance will also go up next year by around 7%.

Disappearing FEHB plans in 2024

Federal employees and annuitants will have fewer plans to choose from for next year, Moss said. Last year, the FEHB program had 271 plans. That dropped to 156 this year. The main reason is that Humana, which offered plans via health maintenance organizations in Florida, Texas and across the Midwest, dropped out of the program. Ditto for the Indiana University Health Plan.

Kaiser Permanente still offers HMOs in Atlanta, Denver, Hawaii, several cities in California and the Pacific Northwest, and the Washington, D.C., area. Moss cautioned: “Kaiser is very specific — that both the human providers and the facilities themselves are all Kaiser-branded. It’s very different than many other, even local HMO plans.”

Some providers offered new plans for 2024, Moss said. Compass Rose added a standard plan, for example. Sentara Health expanded out of the Newport News, Virginia, area to the Northern Virginia area, where tens of thousands of federal employees live.

Although only a small percentage of feds switch plans year to year, Moss said it’s wise to look at your options.

“Even if you’re not motivated to switch your health plan, you still have homework to do every open season,” he said. If nothing else, you’ll want to be sure your current plan is still available and also discover whether any new options have come into your area.

Moss pointed out that prices of specific plans vary, and not all are on the rise.

“In fact, for some plans, the premiums actually went down,” Moss said. “There’s a plan in Texas where the premium went down 50%. It’s Baylor Scott & White. That’s going to save a self-only enrollee about $1,300 next year.”

Some plans shot up as much as 20%, while others will price about level with this year, Moss said. He advised feds to make price only one of their considerations when choosing plans and to also consider specific coverage needs. For more pricing detail, he noted, simply consult the last page of each FEHB plan brochure.

“That’s the premium table,” Moss said. “It shows you what you’ll pay.” The table details prices for self-enrollees, self-plus-one and families. It states prices on a per-pay-period basis.

People with a spouse or partner, but without dependent children, often ask whether they should choose self or self-plus-one.

“If you have two federal employees that are married, you are entitled to have your own plan as a self-only enrollment,” Moss said. “And oftentimes, that’s a way to save some money.”

Anticipating differing medical needs constitutes one reason for self-only by rather than self-plus-one.

Moss added, “But keep in mind that if you if you do make that [self-only] decision, there’ll be an individual deductible each person then will have to face versus both people together in a plan.”

FEHB deductible considerations

A household member thinking he or she might need minimal health care should consider a plan with a high-deductible limit but a relatively lower premium, Moss said. Some high-deductible plans put a portion of a member’s premium into a health savings account (HCA), which has the effect of lowering the plan holder’s out-of-pocket expenses.

The additions typically range from $900 to $1,200, divided over 12 months, Moss said, so you’ll have more at the end of the year than at the beginning.

“And if you’re able to put in a little additional money on your own, this is a really important way for federal employees to save money for health care expenses now and in the future,” he said.

He pointed out that when you turn 65, “you can use those funds in an HSA for nonqualified health care expenses.”

Moss added: “You have to pay normal taxes if you do decide to do that. But basically, it turns into an IRA at that point. You can use it any way that you want.” That includes dental, vision and hearing loss care. Moss said that retirees can use the resulting funds to offset the costs of Medicare Part B premiums.

Plus, HSAs are generally managed by financial services companies, giving the HSA owner choices of investments. “It grows tax free. So any investment returns you receive, you keep tax free,” Moss said. Only on withdrawals after age 65 would you have to pay taxes.

Feds can save a solid amount of money in this manner. “We know many federal employees that have $25,000, $30,000 or $40,000 in their health savings account because they’ve been doing it for a long time,” Moss said.

Attention annuitants

Moss discussed a few items of particular interest to federal retirees. Among the top considerations: Medicare Part D, which covers prescription drug costs. Until now, annuitants didn’t have to think about Part D, Moss said, because drug coverage under most FEHB plans “were as good or better than what you could get from a Medicare Part D plan.”

But a provision in the 2022 Inflation Reduction Act reformed Medicare Part D. For example, it instituted a cap of $35 per month out-of-pocket limit for insulin this year. Starting in 2024, the law ends cost sharing by individuals for catastrophic drug coverage for Part D enrollees with prescription drug expenses of more than $8,000. Then, Moss said, in 2025 comes an out-of-pocket limit of $2,000 for drugs under any Part D plan.

“If you have moderate to high prescription drug costs, this $2,000 cap is going to be really, really important for you,” Moss said. OPM, he added, anticipated these changes “and challenged the plans to offer more Part D coverage to federal annuitants. And the plans have responded.”

Moss said that next year, 17 prescription drug plans will become available under FEHB plans.

“In order for them to be approved by OPM,” Moss said, “they had to offer as good or better prescription drug coverage. We’ve looked at it, and it’s true. It’s as good or better.” He said some plans — including plans from Aetna, Blue Cross Blue Shield and MHBP Federal — went ahead and offered the $2,000 out-of-pocket drug cost limit a year early.

High-income annuitants, as defined by the Centers for Medicare and Medicaid Services, can opt out of Part D, Moss said. That means individuals with $103,000 in adjusted gross income and $206,000 for couples. They would have to pay something called the income-related monthly adjustment, or IRMA. But the adjustment is only $13 a month, he said.

“What’s probably true is that the value of those increased prescription drug benefits are going to be worth more than that Part D IRMA,” Moss said.

He added that annuitants in Medicare Part A or parts A and B who have one these plans, will receive automatic enrollment in the Part D coverage. This includes three Blue Cross Blue Shield plans that cover two-thirds of federal employees and annuitants.

Worth the homework

Above all, Moss urged, take the time to examine the options rather than simply roll over to the same plan.

“Even if you don’t think you want to switch your health plan, don’t assume that your health plan is exactly the same,” Moss said. “We already know the premiums are probably different. Some benefits probably have changed too.” He said the best place check is simply section two of your plan brochure. Brochures are available both at OPM’s website and at that of Consumers’ Checkbook.

As an example of how a plan can change, United Choice Plus Advanced will double its catastrophic limit to $6,000 for self-only members and to $12,000 for self-plus-one, Moss said. “That’s a really big change,” he said. “You have a lot more risk in that plan in 2024 than in 2023.”

Blue Cross Blue Shield plans will add marital and family counseling as part of their mental health services, Moss said.

Also in 2024, plans will expand certain drugs for in-vitro fertilization, although those undergoing fertility treatments will continue to have significant out-of-pocket expenses. A few plans will go further. Moss cited Blue Cross Standard, which will cover up to $25,000 for assisted reproductive technologies including IVF and artificial insemination. Moss called that a huge improvement.

Fertility coverage “is new territory because this is a big expansion of benefits that previously weren’t available,” he said.

Above all, take the time to check out the options. “Far too few will change their health plan in any given year,” Moss said. On average, about 5% do.

“Unless you have an adverse experience, most federal employees will just keep the plan they have,” he said. “The danger in doing that, especially on the annuitants’ side, is there’s a lot of innovation that’s happening, ways for you to save money. If you’re not looking at it, you’re missing out on better benefits. It’s quite possible that you’re overpaying versus some less expensive options that could provide just as good or, in some cases, maybe even better coverage for a lower price.”

Whatever you choose, you won’t find a so-called junk plans in the FEHB program, Moss said.

“OPM has structured this system for you never to have a situation where you would find yourself having something not being covered and have an insurmountable amount of medical debt. That’s really not going to happen in the FEHB program.”

To discover more insights and advice shared during the 2024 Open Season Exchange, visit the event page.

The post Open Season Exchange 2023: Kevin Moss of Consumers’ Checkbook on what you need to know about FEHB plans in 2024 first appeared on Federal News Network.

Caring for your teeth can affect your general well-being.

“There is a pretty important connection actually to your dental health, your gum health, and then to your overall health,” said Haley Landherr, director of business operations and chief of staff at UnitedHealthcare Dental.

Landherr added, dental hygiene “is how your body helps to protect itself against illness. It plays a significant role in your overall well-being.”

Studies have linked gum disease to cardiovascular disease, osteoporosis and diabetes, she said during Federal News Network’s 2024 Open Season Exchange.

“And there’s research that shows that people with gum disease have a harder time controlling their blood sugar levels,” she said, “and that regular periodontal care can help to improve diabetes care management.”

As you change so do your dental needs

UnitedHealthcare’s Federal Employees Dental and Vision Insurance Program plan includes benefits aimed at a total health approach to dental care.

“If you’re managing one or more of these conditions like diabetes, rheumatoid arthritis, COPD, asthma or if you happen to be pregnant, you’re eligible for enhanced coverage that will help you get additional cleanings or different periodontal maintenance,” Landherr said.

She experienced this need personally before giving birth to twins earlier this year. Her dentist emphasized the importance of extra tooth cleanings and flossing, preferably with a water jet device.

“What is so nice about this enhanced coverage is that it gives you some peace of mind,” Landherr said. “Members can focus on other parts of their pregnancy journey and not have to worry about unexpected out-of-pocket costs when it comes to dental care.”

Given that infants soon reach the stage of needing dental care too, Landherr pointed out that people’s dental care requirements change during different stages of life.

“Your oral health is really important through all the stages of your life,” she said and cited the American Dental Association recommendation that dental care start during infancy.

“Make sure you’re cleaning your baby’s gums with a wet washcloth or maybe a child-sized toothbrush,” Landherr said. When teeth appear, use a soft bristle brush with a tiny smear of toothpaste.

“As you get older, it’s important to keep your hygiene up and maintaining your oral health hygiene throughout your life,” she said. ADA recommendations for adults include brushing not only your teeth but also your tongue.

Virtual dental triage? Yep, it’s a thing

People who visit a dentist regularly for cavity and tartar checks might be surprised to find that virtual visits have become part of dental care. Landherr said that UnitedHealthcare Dental plans cover virtual visits.

Acknowledging that a virtual dental visit might be hard to visualize, she described it as the start of a triage situation.

“Dealing with an unexpected dental problem where you have some pain in your mouth, you might try and get in to see a dentist,” she said. “It’s hard to see the dentist; they don’t have availability. Your dental problems probably don’t happen at the most convenient times.”

If the patient can have a video visit and get advice ahead of an in-person visit, it might mitigate the condition and avoid an emergency room visit until the person can be seen by the dentist in the office, Landherr said.

Another benefit of the UnitedHealthcare plan stems from its online presence, she said. The website has enhancements for providers so they can prepare more timely and individualized treatment plans for patients and share information about treatment costs.

To discover more insights and advice shared during the 2024 Open Season Exchange, visit the event page.

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Stigma around mental health and seeking treatment has faded, but it hasn’t disappeared. Yet the need for mental health services for people of all ages has grown since the onset of the COVID-19 pandemic, especially among young people.

“All of that really leads to needing support, how to navigate the health care system and access behavioral health support,” said Dr. Rhonda Randall, executive vice president and chief medical officer at UnitedHealthcare.

She called the need a crisis.

“We know that the pandemic exacerbated what we were seeing prior to that,” she said during Federal News Network’s 2024 Open Season Exchange. “The reports are consistent and clear — especially for women, for adolescents, for seniors, for multiracial adults and for people with disabilities — that there are high rates of poor mental health.”

Knowing when to seek mental health support

Randall said a range of life events can be the catalysts for declines in mental health and that knowledge of them can help people realize if they could benefit from treatment.

“It can include things as common as grief,” she said, “or going through a change in life where you need some support to something more serious — substance abuse and substance use disorders, for example.” But understanding how to navigate one’s way to support is crucial, Randall said.

Federal employees and retirees who enroll in  Federal Employees Health Benefits plans offered by UnitedHealthcare receive specific ways to navigate to mental health care providers appropriate for their individual needs.

“You call that customer service number on the back of your card,” Randall said, “and we’re going to help you get to the right door to get the support that you need. Just as you would if you had a physical illness.”

Randall said a person’s primary care physician is another place to start. “Because when you have that long standing relationship, they’re going to help you navigate this, and often they can get you in quickly.”

For adolescents having trouble academically or with relationships, a pediatrician can service as the gateway to mental health services.

“Pediatricians are now routinely screening youth with just a couple of simple questions around how they’re feeling emotionally,” Randall said.

For crisis situations, she recommended calling 988 or another hotline, or “look into virtual care options, which can often get you in immediately — within minutes — and assist you very quickly.”

Expanded mental health services through telehealth

Randall pointed out that the number of licensed mental health providers per capita varies widely from region to region. In New England, for example, numerous universities turn out mental health graduates in large numbers. The choices are fewer in some Southeastern states, she said.

“One of the things that’s really helped us equal that out is tele-behavioral health and telemedicine because that can be practiced across state lines,” Randall said. “Telehealth is also a really good way to get your care in the privacy of your home. We found that members, patients and healthcare professionals really like this modality of care.”

She also noted the importance of general well-being, one component of which is staying out in front of your mental health and avoiding crises.

“Our goal in all this is to avoid being in a crisis,” Randall said.

People can temper mental health issues by taking care of their total health. “Physical activity, the way we eat and how we take care of our broader physical health very much has a big impact on prioritizing our mental health,” she said. Attending to chronic conditions such as diabetes can support one’s mental health too.

Randall said UnitedHealthcare has made growth in its network of mental health providers a priority. It’s Optum Behavioral Health unit now encompasses about 375,000 providers, of which about 150,000 are available virtually. She said an equally important priority has been enhancing access to the appropriate provider for each plan member.

Plus, UnitedHealthcare has what Randall called an expanding breadth of solutions. These include digital self-help tools and coaching services for people with mild levels of anxiety. Plus, UnitedHealthcare’s Family Engagement Center can help with situations involving children and young adults, which can affect the entire family.

Mental health care can be tough to navigate. But “our care advocates can help guide you to the right care at the right time across that broad range of our network,” Randall said. “You’ll get a personal experience to help eliminate that complexity.”

To discover more insights and advice shared during the 2024 Open Season Exchange, visit the event page.

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