FAQs

1. How do you determine if Medicare or MHBP pays primary?

Information on which benefits pay primary can be found in the in the Official Plan Brochure and at the OPM website.

2. Do I need to file my own claims to get benefits from both Medicare and MHBP?

No. When you are retired with Medicare Parts A and B, all you need to do is show both your Medicare and MHBP ID cards to your doctors and other providers. They should file your claim with both Medicare and MHBP. Notify us when you enroll for Medicare and we will arrange for your claims come directly to us after Medicare pays its share.

3. Do I need to use doctors that participate in your PPO network?

To ensure that you receive the highest benefit level, use doctors and hospitals participating in the network. This is especially true for members who have Medicare as secondary coverage or those who do not have Medicare Part B coverage. If you have Medicare Parts A and B, to get the most from your benefits, it’s best to use doctors who accept Medicare assignment. Your Medicare benefits can be used with any provider accepting Medicare, even if the doctor is not in our PPO network. MHBP will still pay your deductible or coinsurance for covered expenses after Medicare has processed your benefits when you have Standard Option.

4. Do I need Medicare Part D for prescription drug coverage when I have Standard Option?

OPM has determined that the prescription drug coverage offered by plans participating in the FEHBP is, on average, comparable to Medicare Part D prescription drug coverage, thus you do not need to enroll in Medicare Part D and pay extra for prescription drug benefits. If you decide to enroll in Medicare Part D later, you will not have to pay a penalty for late enrollment as long as you keep your FEHB coverage.

However, if you choose to enroll in Medicare Part D, you can keep your FEHB coverage and your FEHB plan will coordinate benefits with Medicare.

Remember: If you are an annuitant and you terminate your FEHB coverage, you may not re-enroll in the FEHB Program.

5. Do I need MHBP benefits if I am an active employee that’s not yet retired?

Because Medicare benefits are limited, you will want additional benefits to fill gaps in coverage - MHBP is a good plan to have. Our Standard Option is one of the best values in FEHBP. Government regulations generally require FEHB Plan members to be enrolled at least five years prior to retirement to carry benefits into retirement. Consult your personnel office to learn more.

6. Who should I contact about enrolling for Medicare?

If you are unsure about your eligibility or how to enroll in Medicare and what it covers, call 1-800-MEDICARE (1-800-633-4227), or visit Medicare’s website.

7. Who do I call to learn how my MHBP benefits coordinate with Medicare?

If you have any questions about coordinating MHBP benefits with Medicare, call MHBP at 1-800-410-7778. You’ll also find more information about coordinating Medicare with MHBP benefits in the Official Plan Brochure (RI-71-007).

 

Note: When you are enrolled in the MHBP Consumer Option and have Medicare Parts A and/or B as your primary payor, the Plan will not waive any deductible, copayments or coinsurance, including the deductible, copayments or coinsurance for prescription drugs.