PEN – 11/11/24 – Today is Veteran’s Day. It is a national holiday for our government – so, they are closed. AND it is also the first day of Open Season. Wait! will our government being closed (OPM) have any effect on postal employees and retirees attempting to make health insurance choices online? Who knows.

I’ve carried health coverage through the FEHB program since 1972…that is 52 years folks. Now all of a sudden, I am being forced into another health program – the Postal Service Health Benefit Program. I am NOT happy about it. Hopefully my attitude will change, but right now all I am seeing is red.

Below are a few areas of interest regarding this forced move into the PSHB program. All of this information comes from OPM folks…not PEN.

Pharmacy Benefits for Postal Service Annuitants (OPM)

Postal Service annuitants and covered family members eligible for Medicare Part D will automatically receive prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP) provided by their PSHB plan.

• An EGWP is a Medicare Part D Plan that is only available to certain individuals.
• The Part D EGWP doesn’t cost any more in premiums and no action is needed to get this coverage.
  PEN: what they do not tell you is the PSHB insurance carriers increased their premiums to cover the cost of Medicare Part D inclusion. They, the carriers, were forced by the Postal Reform Act to include Part D coverage in their plans. Well, they are doing this, but YOUR rates have increased by about 11%. If I am wrong, please contact me and set me straight. Contact Rick
• The enrollee share of premium will increase on average 13.5% for FEHB and 11.1% for PSHB

A PSHB plan Part D EGWP offers a number of advantages:

• The amount of out-of-pocket costs for covered drugs, medications, and supplies won’t be any more (and could be less) than what a person would pay under the regular prescription drug coverage. More often the benefits are less costly and/or more generous than PSHB plan prescription drug coverage.
• In a PSHB plan Part D EGWP, members will receive benefits such as a $35/month cap on insulin products and an annual $2,000 cap on out-of-pocket Part D drug costs.
• In a PSHB plan Part D EGWP, members may have greater access to pharmacy services including in-network and out-of-network pharmacies.

Medicare Part D-eligible annuitants and their Part D-eligible family members may choose to opt out of the PSHB plan’s Part D EGWP prescription drug coverage. If they do, they will not receive any prescription drug coverage through PSHB even though they will pay the same premium for the plan.

• OPM strongly encourages anyone considering opting out to make sure that opting out makes sense for their individual circumstance. Members can call their PSHB plan for more information.
• If a Postal Service annuitant or family member opts out or is disenrolled from the EGWP due to an error, a limited grace period to re-enroll may be available. They may contact the PSHB plan within 90 days to be eligible to have coverage reinstated retroactive to the coverage effective date.
• If a family member of a Postal Service annuitant is not eligible for Medicare Part D, they will receive prescription drug coverage through the PSHB plan prescription drug coverage and not through the PSHB plan Part D EGWP.

Other Considerations

• While every PSHB plan offers a Prescription Drug Plan (PDP) EGWP, only some PSHB plans offer a Medicare Advantage Prescription Drug (MAPD) EGWP. An MAPD EGWP offers comprehensive coverage, and often added benefits that are not covered under the regular PSHB plan. Because of these important differences, anyone currently enrolled or considering enrolling in an MAPD EGWP should contact the PSHB plan directly for any questions.
• A Postal Service annuitant or family member already enrolled in a separate Medicare Part D plan should notify the PSHB plan as soon as possible if they want to keep that plan. Under Medicare rules, no one can be enrolled in two Part D plans at the same time.
• A Postal Service annuitant or family member living outside of the 50 states, D.C., and the U.S. territories will not receive drug benefits through Medicare Part D, as that benefit is not available overseas. Instead, they will receive prescription drug coverage through the PSHB plan’s regular pharmacy benefits, not through the PSHB plan Part D EGWP.

Find the above information here: https://www.opm.gov/healthcare-insurance/pshb/#url=Pharmacy-Benefits

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PSHB Plans vs. FEHB Plans:

• As part of the FEHB Program, PSHB plans will cover the same set of comprehensive health benefits included in FEHB plans. PSHB plans will be offered by many of the same carriers that offer FEHB plans.
• There are a few important differences for PSHB enrollees:
  • The PSHB plan year will run from January 1 through December 31 each year. This is the same for annuitants covered by FEHB, but different from the FEHB plan year for employees, which begins on the first day of the first full pay period in January each year.
  • As required by the Postal Service Reform Act of 2022 (PSRA), certain Medicare-eligible Postal Service annuitants and their Medicare-eligible family members must enroll in Medicare Part B to remain enrolled in a PSHB plan. There are some exceptions to this requirement described here.

Find this information here: https://www.opm.gov/healthcare-insurance/pshb/#url=Overview

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Carrier Customer Service Numbers

Good luck to all of you!

Rick Owens
PEN