Medicare Integration: Specific Rules for Uncommon Situations

         Anytime there is a major legislative change, such as the Medicare Integration obligation of the Postal Service Reform Act (PSRA) of 2022, there are always specific rules regarding not so common situations. Nevertheless, they need to be mentioned.

1)      If you are a letter carrier and are retired or will be retired under the Office of Workers Compensation (OWCP) you will not be required to enroll in Medicare Part B. This is true for the Special Enrollment Period (SEP) or the 7-month period surrounding the month you turn 65. This does not mean you cannot enroll in Medicare Part B, it’s just not a requirement. As an OWCP retiree with Medicare Part B your Federal Employee Health Benefit (FEHB) which in 2025 becomes your Postal Service Health Benefit (PSHB) is your primary coverage and Medicare Part B is your secondary coverage. Again, this is only for OWCP retirees with Medicare Part B.

2)      Some carriers retire from the USPS before age 65. In the past if you did and continued to work at another job you could sign up for Medicare Part B after you retired from that second career without penalty if you are then past 65 by more than 3 months. That is no longer the case. If you fit into this category, you MUST enroll in Medicare Part B either in the SEP or at turning age 65. Failure to do so will mean the loss of your FEHB/PSHB eligibility.

3)      The SEP is winding down. If you are eligible for SEP you have to enroll by the end of the day September 30, 2024, to enroll. You should have already received notification regarding eligibility and a notice to respond to the Office of Personnel Management (OPM) as to your choice. Your enrollment package should have included a) A notice with instructions on how to apply for USPS SEP b) A return envelope addressed to: Social Security Administration

                                                                 Wilkes-Barre Direct Operations Center

                                                                PO BOX 67650

                                                                 Wilkes-Barre PA 18767-7650

The return envelope will have USPS PSHB PSRA on it. C) An Application for Enrollment in Medicare Part B, Form CMS-40B which will have questions #6 and #8 prefilled by USPS with “PSRA Special Enrollment Period” included there. There will also be an extra copy of the Notice and Form CMS-40B to be submitted to Social Security. Keep copies of all paperwork submitted for your records!

4)      The change over from FEHB to PSHB this open season for year 2025 does not affect eligibility for your other Federal Benefits. These are Federal Employees Dental and Vision Insurance Program (FEDVIP), Federal Employees Group Life Insurance (FEGLI), Federal Long Term Care Insurance Program (FLTCIP), or Flexible Spending Account Program (FSAFEDS). Make sure that your FEHB plan is available in the PSHB. If it isn’t you must make another choice during Open Season. If this happens and you don’t make a choice the PSRA requires OPM to choose the lowest available cost plan for you. That choice may not fit your health needs.

5)      Open Season begins Monday November 11, 2024, and ends Monday December 9,2024. One can imagine that the system will be extremely busy during that time. The last thing any of us needs is to then find out that our on-line access to OPM has a problem. Both active and retired carriers should try logging in prior to this time just to make sure all is well. For active carriers make sure your Lite Blue log-in is active with your employee ID and password. For retirees make sure your access to OPM is trouble free using your CSA number and password.