Retired Fed - Switch to FEP Medicare Prescription Drug Program?

[Anonymous]

Just got a letter from BCBS about switching to FEP Medicare Prescription Drug Program Part D....

What are the reasons to do this or not to do this?

[Anonymous]

OP here - just doing and posting some research

https://www.govexec.com/pay-benefits/2023/03/medicare-part-d-changes-federal-annuitants/383469



Part D Premium Increase Limits

Starting in 2024 and lasting through 2030, the IRA limits Part D premium growth to no more than 6% per year. Part D premiums increased 10% on average from 2022 to 2023, so the 6% cap offers some protection from large price hikes in the future.

Catastrophic Coverage Coinsurance Dropped

Once total spending between the Part D enrollee, Part D plan, and drug manufacturers reaches $7,400 in a year, catastrophic coverage begins. Currently, the enrollee pays 5% of expenses in the catastrophic coverage phase. Beginning in 2024, Part D plans will eliminate the 5% enrollee share.

2025 Change

Out-of-Pocket Spending Cap

In 2025, there will be a new $2,000 enrollee out-of-pocket spending cap in Medicare Part D plans. Additionally, enrollees will have the ability to spread out the $2,000 of out-of-pocket costs over the course of a year.

This Part D change will produce substantial savings for annuitants with high out-of-pocket drug costs. For those needing expensive brand or specialty drugs to treat cancer, multiple sclerosis, or other medical conditions, joining a Part D plan will be a huge cost saver, unless FEHB plans modify their offerings to match this benefit.

Why such big savings? Because the soon-to-be $2,000 out-of-pocket maximum in Part D is significantly lower than almost all catastrophic limits seen in FEHB plans, which range from as low as $1,500 to as high as $9,100 when using in-network providers for self-only enrollment.

[Anonymous]

Check the drugs you take. Ours are not listed or we will be forced into generic. You will loose the CVS Caremark option. It will cost you nothing to stay with the plan you’ve enjoyed for years. We are opting out. If you don’t opt out you will automatically enrolled in the Medicare/FEP option.

[Anonymous]

Make sure you are comparing apples to apples. The $2000 limit in the Part D plan pertains to prescription drugs only. I think the catastrophic limits you mentioned for the FEHB plans are medical limits. Completely different.
Also, a word of caution about that 6% limit n premium increases. The 6% limit is calculated on an average basic premium— it doesn’t apply to the premium of any specific plan. In other words, the premium for your plan could in fact increase more than 6% from one year to the next. In fact, many people with stand alone Part D plans are seeing increases well above 6% for 2024.

[Anonymous]

If you use a co pay card (assistance from the manufacturer) for any medication, be aware that you can't use them with Medicare so your costs will go up dramatically.

[Anonymous]

There is no benefit to this new Medicare option, only loss of benefits. We are opting out. If you don’t opt out in two different places, you will be automatically enrolled in the Medicare option.
I opted out by calling our FEP blue customer service line. I was told that we must also opt out on a “survey” quote that we will be receiving. All of this is very deceiving and confusing.

[Anonymous]

Anonymous wrote:There is no benefit to this new Medicare option, only loss of benefits. We are opting out. If you don’t opt out in two different places, you will be automatically enrolled in the Medicare option.
I opted out by calling our FEP blue customer service line. I was told that we must also opt out on a “survey” quote that we will be receiving. All of this is very deceiving and confusing.

That’s what caught my attention!

[Anonymous]

Anonymous wrote:There is no benefit to this new Medicare option, only loss of benefits. We are opting out. If you don’t opt out in two different places, you will be automatically enrolled in the Medicare option.
I opted out by calling our FEP blue customer service line. I was told that we must also opt out on a “survey” quote that we will be receiving. All of this is very deceiving and confusing.

Can you explain in more detail what you mean by "loss of benefits"? what do you lose?

[Anonymous]

Anonymous wrote:There is no benefit to this new Medicare option, only loss of benefits. We are opting out. If you don’t opt out in two different places, you will be automatically enrolled in the Medicare option.
I opted out by calling our FEP blue customer service line. I was told that we must also opt out on a “survey” quote that we will be receiving. All of this is very deceiving and confusing.

Can you explain in more detail what you mean by "loss of benefits"? what do you lose?

[Anonymous]

From the link I posted earlier:

Earlier this year, the Office of Personnel Management encouraged FEHB plans to offer more Part D options so that federal annuitants could benefit from improved prescription drug coverage. In a letter to FEHB carriers, OPM offered two ways for FEHB plans to provide Part D coverage—Part D Prescription Drug Plans, which had never been offered to annuitants before, and FEHB Medicare Advantage Plans, which have been available over the last few years.

(snip - list of health insurance plans here)

To receive OPM approval, the PDP must provide as good or better prescription drug benefits than the FEHB plan, at no additional cost. After our review of the 2024 PDP benefits, we concur with OPM’s assessment. The PDP benefits are as advertised and are at least as good as the FEHB prescription benefits, in some cases with even lower out-of-pocket prescription drug costs. This is especially true for the PDPs, marked above, that provide the $2,000 prescription drug maximum out-of-pocket, a year earlier than what is required by law. (note from OP -- that includes BCBS Standard, but not Basic, this year) [b]Annuitants with moderate to high prescription drug costs will benefit greatly from enrolling in one of those plans next year.


If you are a member of an FEHB plan offering a PDP and are enrolled in either Medicare Part A or Medicare Parts A & B, you’ll be auto-enrolled in the PDP plan for prescription drug coverage. BCBS plans are the exception to the rule; they will only auto-enroll when you have both Parts A & B. Your plan will send you written notification of the auto-enrollment, and you’ll have 30 days to opt out of the PDP. After the 30 days, you’ll receive a new prescription drug insurance card, and your Part D coverage will begin 1/1/2024.

OK, I thought it was a little suspicious when I saw that BCBS was making me opt out not opt in, but at least according to this article, the plans are supposed to provide better coverage, and it is in a response to a federal change requiring Medicare Part D plans to provide better coverage for prescriptions.

So yeah it makes sense to BCBS to urge retirees to move to this plan because it's going to save them money but it looks like it should also save me money?

[Anonymous]

Are you by any change the same person who posted one day earlier:

"We are retired Feds on Medicare w FEP BC/BS as our secondary and we pay high premiums. One of the reasons we chose this as our secondary is because we did not want to be held to the restrictions of the Medicare drug plans.
We received notification before open season that we are being forced into a Medicare drug plan specifically for federal employees. This plan is being aggressively marketed.
We take two expensive medication‘s and one of them is not even listed on their plan. The other drug will force us into the generic version, which is not effective.
I make this post to warn others who may carry the same plans to be diligent. You will need to opt out of the Medicare drug plan in 2 different places or you will be automatically enrolled in Medicare without any change in premiums.
It would be too much to explain in a post so do your research."

Also retired Fed who is turning 65 not yet taking SS. The whole thing is a confusing mess! And changes like this (Plan D) don't make it easier...

[Anonymous]

Anonymous wrote:Are you by any change the same person who posted one day earlier:

"We are retired Feds on Medicare w FEP BC/BS as our secondary and we pay high premiums. One of the reasons we chose this as our secondary is because we did not want to be held to the restrictions of the Medicare drug plans.
We received notification before open season that we are being forced into a Medicare drug plan specifically for federal employees. This plan is being aggressively marketed.
We take two expensive medication‘s and one of them is not even listed on their plan. The other drug will force us into the generic version, which is not effective.
I make this post to warn others who may carry the same plans to be diligent. You will need to opt out of the Medicare drug plan in 2 different places or you will be automatically enrolled in Medicare without any change in premiums.
It would be too much to explain in a post so do your research."

Also retired Fed who is turning 65 not yet taking SS. The whole thing is a confusing mess! And changes like this (Plan D) don't make it easier...

OP here … no that wasn’t me!

Ok sounds like for that poster the drawback is that the new Medicare part d plan doesn’t cover their expensive drug?

[Anonymous]

Whelp. We made the switch and immediately have been having prior authorization problems out the wazoo. Do not recommend.

[Anonymous]

Yep! We are having terrible trouble with “prior authorization “ requirements!! Replacement drug is 10x more.
We are switching back asap.

[Anonymous]

Anonymous wrote:Whelp. We made the switch and immediately have been having prior authorization problems out the wazoo. Do not recommend.

What does "prior authorization" mean?