Federal Retiree Health Insurance and SilverScript.............

Vladimir · November 25

I just received a letter from GEHA that they are enrolling me in Medicare Part D prescription plan!! Automatically, if I don't do something. The program is call Aetna Medicare Rx offered by SilverScript. The reviews of SilverScript were enough to get me to opt out.

I have a lot of concerns about Medicare Part D, which is why I did not enroll the first time around, choosing the keep my prescription benefits with GEHA.

They do have a number you MUST call to opt out. It only took TWO HOURS plus to finally opt out. AND you must do it by December 5th, otherwise they will automatically enroll you in Part D.

Is GEHA, the only one that is running this "program" among the Federal retiree health plans?? I think I have had enough of GEHA. Are the Blue Shield and other plans shifting their clients to Medicare Part D???

On a different note. I did tell them that I was recording the phone conversation. The first guy was fine with it, but when I was transferred to the second person to cancel they said that they would discontinue the conversation unless I stopped the recording.

First time that has happened. I did tell them, after they told me that, thatI was using this recording as proof that I complied with all the requirements for cancelling the transfer to Medicare Part D.

Any advice a a new health plan for next year???

trailertraveler · November 26

Blue Cross and Blue Shield tried to do similar to me last year. I only found out because I suspended my FEHB insurance and enrolled in a Medicare Advantage Plan. The Part D switch caused all kinds of grief, but I finally got the FEHB suspended and got wife and I enrolled in Advantage PPO Plans. Saved about $8,400 in FEHB premiums plus got better dental and eye care benefits. Used the Advantage Plan on the road for a root canal with no issues.

Chalkie · November 26

You are more or less required to have Part D but you are also able to pick and choose your Part D separately from Medicare A/B. My sister and BIL each have a different Part D as they take different medications and shopped the Part D to find the best coverage for each. As a military retiree my Tricare for Life is my Part D.

Next year shop around and find the best Part D for you. If you are healthy and take no medications then find the cheapest you can no matter who it is with. Otherwise find the one that suits best for whatever medications you do take.

TXiceman · November 26

By all means, shop your Part D separately. My Wife and I are dropping Silver Script as they bumped our premium and doubled our deductible. along with $5 minimum on tier one and two drugs. Wound up going to Humana Part D and it is still a bit higher but than last year, but not outrageous.

Ken

Vladimir · November 27

7 hours ago, Chalkie said:

You are more or less required to have Part D but you are also able to pick and choose your Part D separately from Medicare A/B. My sister and BIL each have a different Part D as they take different medications and shopped the Part D to find the best coverage for each. As a military retiree my Tricare for Life is my Part D.

Next year shop around and find the best Part D for you. If you are healthy and take no medications then find the cheapest you can no matter who it is with. Otherwise find the one that suits best for whatever medications you do take.

I am confused. I never have seen anything that requires Part D.

GEHA has prescription benefit as part of my health insurance. In fact, they said if I refused the transfer to Part D my current prescription benefit remains.

After looking at the reviews of SilverScript, there is no way that I would want to do business with them. The reviews on a scale of 1 to 5......they average 1.1!!! Those are real awful numbers.

I just had several prescription refilled and it was cheaper than the fee schedule in Part D!!!. Last year, I paid for all my prescriptions using Good RX and paid out of pocket for a years fill at one time.

That was cheaper than going through Part D, or even my current insurance.

All my drugs are generics so really inexpensive.

I guess it might be different if I had expensive drugs.

Kirk W · November 27

15 hours ago, TXiceman said:

My Wife and I are dropping Silver Script as they bumped our premium and doubled our deductible.

We changed from Silver Script to WellCare two years ago for much the same reasons. The Medicare website says: "Deductibles vary between Medicare drug plans. No Medicare drug plan may have a deductible more than $545 in 2024 ($590 in 2025). Some Medicare drug plans don't have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible."

12 hours ago, Vladimir said:

I am confused. I never have seen anything that requires Part D.

With regular Medicare, part D isn't mandatory but if you do not have some form of prescription drug coverage the part D premiums will be higher when/if you do enroll. For retried federal employees it is quite different. "Medicare Part D is not mandatory for retired federal employees because most already have creditable prescription drug coverage through their Federal Employees Health Benefits (FEHB) plan, meaning they can usually delay enrolling in Part D without penalty; however, they should compare their FEHB coverage to Part D options to see which best suits their needs."

Chalkie · November 27

12 hours ago, Vladimir said:

I am confused. I never have seen anything that requires Part D.

From the Medicare site:

Quote

Most people only pay their Part D premium. If you don't sign up for Part D when you're first eligible, you may have to pay a Part D late enrollment penalty.

This is why I said more or less. If it was not mandatory why would you have to pay a late enrollment penalty?

bigjim · November 27

I am with GEHA and on medicare but have not received the notice you got about changing me to part D. I am concerned that since my mail is forwarded from Livingston that I have just not received it yet and if I don't get it before open season closes I may not have a chance to opt out if given the choice. Time will tell about that. I am wondering which GEHA plan you have Vlad. I have had high option and may stay with it next year. I know you have had issues with GEHA that I have not.

trailertraveler · November 28

It appears that several of the comments are from folks that are not enrolled in or are unfamiliar with the FEHB (Federal Employee Health Benefits) insurance program. If my memory is correct, all the FEHB plans have drug coverage both before and after signing up for Medicare part A & B. I don't think that there is any FEHB plan that functions like Medicare supplement plans. When I retired over 20 years ago, FEHB premiums were the same whether you signed up for Medicare or not. The plans I have had did cover all copays for doctors, but not for drugs. They also paid all costs above what Medicare would pay. As I mentioned in my previous post, my Blue Cross/Blue Shield FEHB plan tried to switch me to their Part D plan. Since I was suspending my enrollment in FEHB and switching to a Medicare Advantage Plan I did not research what that really meant. Proving that I had Drug coverage under FEHB to avoid the Medicare Part D premium penalty was a bit of a challenge.

Edited November 28 by trailertraveler

Vladimir · November 30

On 11/27/2024 at 11:19 AM, bigjim said:

I am with GEHA and on medicare but have not received the notice you got about changing me to part D. I am concerned that since my mail is forwarded from Livingston that I have just not received it yet and if I don't get it before open season closes I may not have a chance to opt out if given the choice. Time will tell about that. I am wondering which GEHA plan you have Vlad. I have had high option and may stay with it next year. I know you have had issues with GEHA that I have not.

I have Standard option for GEHA. You will not believe the premiums for Blue Cross!!! So I guess I am staying with GEHA and watching every bill and documenting every conversation.

To opt out of Plan D....you MUST contact SilverScript by December 5, 2024 at 1-833-250-3241. They are open 24 hours a day, 7 days a week.

They have GEHA's medical information. You will need your card when calling.

In my case, they first said there was no record of my health insurance with GEHA, even though I am the primary. I told them to go ahead and find my wife, and they did. From there, they finally found TWO records for me, one with an inactive account and another with the current account.

I believe sometime in the past 50 years I had GEHA on a single account and when I switched over to Blue Cross for years I guess that is when it became inactive. It was not a smooth phone call. It took over two hours to cancel the switch.

Be prepared to wait.

If you don't have your mail, I would call GEHA customer service and ask them to explain what happens.

In my case, I just looked at the reviews of SilverScript and said I don't want anything to do with them.

I did not closely look at the costs of Plan D versus GEHA but it looked like $9 or $15 for generics and currently my GEHA cost is $3.38 to 16.59. Paying out of pocket at Cost PLus was $5.60 to $8.60, but they have a $5.00 shipping charge which I don't know if it applied per drug or for all five. Costco out of pocket was $9.99 to $17.10. This year I did not use Good Rx since I just filled 90 days instead of a year, but they were real cheap for a year supply last year.

Dealing with GEHA is enough for me.

Edited November 30 by Vladimir

Kirk W · November 30

8 hours ago, Vladimir said:

Dealing with GEHA is enough for me.

You make me appreciate having Medicare and Medigap with an HRA from my previous employer. I also have VA access but use them very little since I have a copay with them.

Edited November 30 by Kirk W
Add information.

bigjim · November 30

Vlad thanks greatly for the update. It will be very helpful to me I believe as I just got my letter about switching me to Part D. It talks about follow up information that I would likely not get in time. Your logic about this seems good. In my case just to complicate matters I am getting almost all my meds currently through the VA due to certain issues in the last year and a half or so. I have copays for meds through the VA that are reasonable but they are not as convienent to use as was CVS mail order through GEHA. I WILL be making the phone calls and again your feedback is very helpful. Especially given the short time frame I have left.

Vlad have you or anyone else using GEHA filed for a partial premium reimbursment. I think it is a partial refund of your medicare premiun. I was not aware of that but learned of it at about the time of the start of open season. I was able to file for both 2023 and 2024 and am expecting 2 checks soon. I saw where that the reimbursement for 2025 will be $1000. which will make the premium increase a little more palatable.

bigjim · November 30

Kirk, essentially our GEHA is our medigap insurance. It is the one we chose over other options and we could change plans each year at open season if one looks better. After Vlad comments I am going to look closer at the options within GEHA keeping in mind that you have to look based on each individuals circumstance. Even then it somewhat of an educated best guess. As I said the fact I have been using the VA complicates my choice somewhat.

Vladimir · December 1

8 hours ago, bigjim said:

.....................Vlad have you or anyone else using GEHA filed for a partial premium reimbursment. I think it is a partial refund of your medicare premiun. I was not aware of that but learned of it at about the time of the start of open season. I was able to file for both 2023 and 2024 and am expecting 2 checks soon. I saw where that the reimbursement for 2025 will be $1000. which will make the premium increase a little more palatable.

No.

Do you have the information handy?? I thought that was just for the Medicare Advantage plans.

bigjim · December 1

The phone # I have used is 844-768-5644. I had to have them mail me blank forms and it had to be forwarded through Livingston but supposedly you can do it all on line if you have the capabilities. The one that is critical if you have not filed is the one for 2023. I don't know if this only applies to people that have GEHA high option or not. That is how I learned about it when checking high option for next year and noticed it talked about $1000. refund for 2025. You might check geha.com/MRA or geha.com/HealtEquity. According to some instructions they mailed me claims can be submitted online or using EZ Reciepts application . Again assuming you quaify

bigjim · December 2

Vlad, definitly follow up on your own but as I was trying to work through some of this I believe I found that it only applies to high option. I also saw there is an option that is geha medicare advantage and the reimbursement for 2025 will be higher than for the high option. Did not get much about the medicare part D option but I saw where you have to opt out as you have stated. I will be manning the phones tomorrow for sure.