Get the Most from Federal Employee Health Benefits

The quality of health insurance is one of the key attractions in the compensation package for employees of the federal government. The cost of that attraction will rise modestly in 2022. Federal employee health benefits will increase by an average of nearly 4 percent next year, per the Office of Personnel Management (OPM).

The Federal Employees Health Benefits Program (FEHBP) covers over eight million people and is the largest employer health plan in the world. As such, making exact statements over what each federal employee across the 275 plan choices will get for an increase in 2022 is impractical.

What we can say is that this increase, while far from ideal, is still less than the 2020 increase, which averaged 5.6 percent across the board. To a certain extent, the increase and the ‘20 premium hike are making up for a near-record low 1.5 percent increase back in 2019. OPM further estimates that the increase for federal employees is running lower than most other public sector plans. For example, state employees will see premium hikes of nearly 5 percent in 2022.

Getting the Most from Your Benefits

Regardless of whether one considers the 2022 premium increase high or low by historical standards, every federal employee should want to get the most out of their benefit plan. That starts with making certain your claims are being paid and getting a fair hearing on those that are not.

Appealing a Denied Claim

If your carrier denies a claim–either in full or in part–don’t simply accept the denial without looking into it. With the help of a qualified federal benefits attorney, look through your plan to review the coverage. If it’s determined that you have a case for coverage, the federal government has a specific process that must be followed. That starts by reaching out to the carrier directly with a written summation of why you believe the claim is eligible for coverage. Writing to the carrier first is a prerequisite for any further review by OPM.

In the event you and the carrier don’t come to a resolution, you can then appeal with OPM. You will typically receive a reply within 60 days. If the claim is still not resolved to your satisfaction, there are options to go into the court system. Your specific options will depend on the laws in your state.

Disability Retirement

During what has been a tumultuous two years for employers and employees in all sectors, a lot of people are looking into their retirement options. One such possibility for federal employees is disability retirement. This exists for people who might not be old enough, nor have enough service time for “regular” retirement but struggle with medical conditions that prevent them from fulfilling their job responsibilities.

Disability retirement requires good documentation–the government must get a reliable medical report that recommends against you performing certain job functions. Furthermore, it must be demonstrated that the specific agency has made every reasonable attempt to accommodate your disability. These “reasonable attempts” can include reassignment to a job with different duties.

What this means is that disability retirement is not something one can simply “decide” to take. On the flip side, it only requires that you be unable to perform one job function to be eligible. If this is something you believe applies to you, reach out to us. It requires preparation and good documentation, but if you’re no longer able to do your job, it is most certainly an option.

Medicare Decisions

If retirement time is near, for whatever reason, making decisions on healthcare is important. OPM provides some basic guidance on federal employee health benefits in retirement. One of the issues to resolve is what will happen with Medicare.

Most federal employees qualify for Part A Medicare, which is financed by the FICA payroll tax. The only reason you (or an employee in any sector for that matter) would not qualify under Part A is if you have not accumulated forty quarters (ten years) of payroll tax credits. Presuming you do qualify, enrollment in the premium-free Part A plan can be done within six months of your 65th birthday.

For those that work beyond the age of 65, Part A will pay secondary to the basic FEHBP plan, including deductibles and copays.

The best path on Medicare Part B will vary by individual, with the decision on whether you will continue working being a key variable. Part D deals with prescription drugs and is optional. In most cases, the FEHBP plan will offer Rx coverage as good as what it is in Part D, thereby making enrollment optional.

Keeping Your Standard Healthcare in Retirement

The above discussion about Medicare presumed that retirees would be able to continue with their regular health insurance coverage into retirement. To do so, you must have been continuously covered by FEHPB program (or TRICARE, Civilian Health, CHAMPUS, or other federal health plan) for five years prior to retirement. Your coverage for this period should be continuous.

In other words, if you have been working for the federal government and getting coverage for the last five years, you will likely qualify to keep your coverage into retirement.

The health insurance plan and other component parts of the federal government’s benefits package can provide terrific coverage and security for you and your family. But it is important to know the details–not just what’s in the plans, but how to best access them. The world of insurance coverage is arcane, but you don’t have to feel overwhelmed. Here at The Law Firm of John P. Mahoney, Esq., Attorneys at Law, PLLC, we’re committed to having deep expertise on issues that matter to federal employees. If you have questions on any aspect of your federal benefits package, don’t hesitate to give us a call at (202) 350-3881 or contact us online.