Federal Employees Health Insurance and Medicare

[RExplorer]

I’m trying to help my elderly parents with a new insurance problem and thought someone here might have experience with this. 

They’re in their 80’s and have had original Medicare since retirement.  In addition, they have retiree insurance through GEHA, which acts as secondary payer.  Last year GEHA sent a lot of marketing materials trying to get people to switch to a GEHA Medicare advantage plan.  There wasn’t any benefit for my parents to do that and we opted to keep them on OM.

But then after Jan. 1, they suddenly had no drug coverage.  When my dad called about the problem, they told him they could enroll him for drug coverage starting Feb. 1.  He told them he wanted everything to stay the same from 2024, just fix the drug coverage that was suddenly missing. 

I’m looking everything over today and they switched his enrollment from OM to MA.  I’m trying to gather info and understand before I get on the phone with him to try to resolve this.  But I’m not sure where to even start.  They’ve never had to make a change in the past, but it seems something changed with drug coverage for 2025.  Have FEHB plans dropped drug coverage except through MA plans?  My parents have not had a supplemental plan, as the GEHA as secondary payer acted in that role. 

I don’t know what I don’t know at this point.  Any insight or suggestions on where to start?

[Catbert]

Is your dad a retired Federal employee?  Is there a reason he opted to take Medicare at 65 rather than just staying on an FEHB plan?

Is he by chance a former Postal employee?  Starting this year newly retired Postal employees will have to take Medicare when they turn 65.  Postal employees who retired previously didn't/don't have to pick-up Medicare, but they did need to go in during FEHB open season and make an election. 

[RExplorer]

He is retired postal employee — but retired 20+ years.  Was the GEHA like OM then (until they started pushing MA plans)?

My mom has dementia and my dad has his hands full with her.  This kind of insurance stuff gives him a lot of stress.  So I’m trying to figure out as much as I can without his involvement to save him some stress. 

It seems to me we should be able to switch him back to whatever he had previously, if it still has drug coverage.  GEHA was really pushing the MA plans last year.  He was constantly getting stuff in the mail and every time it stressed him out.  I wonder if there was some other issue with his drug coverage and the rep he talked to just switched him over to their MA because they’ve been pushing that so hard?

[Catbert]

I don't know if these links will help or whether your father's problem is related to this change.  There is a phone number, but I'm not sure how helpful it will be.  I'm sorry you're having to deal with this.

https://www.opm.gov/healthcare-insurance/pshb/#:~:text=Postal%20Service%20employees%20and%20Postal,coverage%20through%20the%20Postal%20Service

https://www.myfederalretirement.com/phsb-postal-health-benefits/

[RExplorer]

Thank you — both of these link are helpful.  He showed me every time he got mail about MA.  But nothing he showed me ever said to me that they were making this change over to PSHB.

What surprises me is that he hasn’t had any issues at doctor appointments, as it seems his old insurance card shouldn’t have worked there either. 

In any case, a fun phone call is on my to do list. 

[Catbert]

You might also try looking at the PSHB website at the particular plan they enrolled him in.  Maybe there are somehow two versions of GEHA and they transferred him to the wrong one?  Or maybe GEHA covers drugs, but somehow it isn't recognized in "the system"?

Can you find a retired PS employee website/forum where others may have encountered this problem and at least know the source.

Sorry I can't help more.

 

[RExplorer]

You did help — I hadn’t found those links and they got me going in the right direction I think. 

He definitely has both OM and GEHA.  So Jan. Doc appointments fell under OM and billing hasn’t yet caught up (what would normally have been covered by GEHA).  I think in the volume of what I consider to be over-zealous MA marketing he received there was notice about having to enroll in a new GEHA plan under PSHB and it was lost/not noticed among the pages and pages and pages of MA info.   

When he called about the drug problem earlier this month I don’t know what went wrong.  Did he say ok to MA based on cost, was MA pushed (over staying on OM)?

Going to call with him tomorrow.  The MA isn’t effective until 2/1 and the info we have says he can change back to OM at any time.