Q&A about Health Reform

General Questions

Q:   How will the Affordable Care Act (ACA) affect me as a member of the Service Benefit Plan?
A:  While the ACA expands access to insurance for millions of Americans and broadens health insurance benefits, it doesn’t have a big impact on most federal employees covered by the Service Benefit Plan. The two main changes for FEHBP plans include  expanding women’s preventive care benefits and extended eligibility up to age 26 for covered young adult children.
Members of Congress and certain congressional staff will not be eligible to participate in the FEHBP as employees beginning in 2014.

Q:  With an increase of insured people, will there be enough providers in the Blue Cross and Blue Shield network?
A:  The Blue Cross and Blue Shield Service Benefit Plan relies on the provider networks of all the local Blue Cross and Blue Shield Plans throughout the United States. This network has the largest number of hospitals, physicians and specialists of any health insurer in the country. We are always working on improving our network to make sure members have access to the care they need.

Q:  How will the ACA impact overseas members?  

A:  In general, any ACA changes made to the Service Benefit Plan will also apply to members who live overseas. Examples include the extension of dependent coverage from age 21 up to age 26 and the expansion of preventive services coverage for women.

Q:  Does the ACA affect prescription drug coverage? 
A:  No. The ACA does not affect prescription drug benefits for anyone with Blue Cross and Blue Shield Service Benefit Plan coverage.

Q:  With all of the changes required by the ACA, will the Blue Cross and Blue Shield Service Benefit Plan stay viable as an insurance provider?
A:  We believe that Blue Cross and Blue Shield Plans are well positioned to provide coverage with health reform, continuing to offer value to our customers for decades to come. Blue Cross and Blue Shield Plans have offered the Service Benefit Plan since the FEHBP began in 1960, remain committed to the Program, and will work hard to meet any future challenges.   

Q:  Will the ACA limit or restrict benefits offered by the Service Benefit Plan? 
A:  No. Your benefits will not be limited or restricted as a result of the ACA. In fact, the ACA expands the benefits offered by the Service Benefit Plan—for example, by extending the coverage of dependent children up to age 26 and by adding some preventive benefits at no additional cost to members.

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Medicare Questions

Q:  I have Medicare and Service Benefit Plan coverage. How will the ACA affect the way these health plans work?
A:  It won’t. Currently, for members who have Medicare as their primary payer, the Blue Cross and Blue Shield Service Benefit Plan offers a strong, comprehensive benefits package. The ACA does not change this.

Q:  Will it still be necessary to have both Medicare and the Blue Cross and Blue Shield Service Benefit Plan?
A:  This has never been required, but having both gives you additional coverage. While Medicare pays a significant part of your healthcare costs, it leaves some gaps. Your Service Benefit Plan coverage plus Medicare coverage work together to increase your benefits and lower your out-of-pocket costs. 

Q:   I have both Medicare A and B and Blue Cross and Blue Shield Service Benefit Plan coverage. Will the ACA have an effect on what I should have in order to maximize benefits with the least cost? 
A:  No. When you have Medicare Part A and Part B plus the Service Benefit Plan, most of your covered services are paid in full, and you do not have any out-of-pocket costs. The Service Benefit Plan pays the Medicare Part A deductibles and coinsurance amounts for covered services. When you have Medicare Part B, we pay the Part B deductible and coinsurance amounts. Plus, you won’t have to pay the Service Benefit Plan deductible, coinsurance and copayment amounts for covered services. The Service Benefit Plan also provides prescription drug coverage.

Please read the Blue Cross and Blue Shield Service Benefit Plan’s federal brochure (RI 71-005) for additional information.

Q:  Why doesn’t the Service Benefit Plan cover prescription copayments for those who have Medicare Part B?
A:  We understand that prescription costs can be a hardship for retired people with fixed incomes. However, it is important to remember that eliminating copayments and deductibles will usually increase premiums. Completely waiving prescription copayments for Service Benefit Plan members with Medicare Part B would not be cost-effective and would significantly increase premiums.

Q:  Can you explain how the "donut hole" coverage gap works? How will it affect those of us who have Medicare (Part D) as well as the Service Benefit Plan for prescriptions?
A:  The “donut hole” is a feature of the prescription drug benefits available under Medicare Part D, either through separate Medicare Prescription Drug Plans or as part of Medicare Advantage Plans, which also cover hospital and professional services.

The “donut hole” is an annual coverage gap that is a feature of Medicare Part D.  It occurs because Part D’s coverage temporarily stops after the benefits it has paid reaches a certain dollar amount and does not resume until the person (or certain others on his behalf) has spent a certain amount.  Once the “donut hole” is satisfied, the Medicare Part D plan will cover almost all of the cost of covered prescription drugs for the rest of the calendar year.

The benefits that the Service Benefit Plan pays as the secondary payer to a Medicare Part D plan do not count toward satisfying the “donut hole.” 

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Questions about Insurance Costs

Q:  I am concerned about rising health costs. Will they rise?
A:  We are all entering a new environment that will be very different from today’s health insurance marketplace. No one can accurately predict exactly what impact all the changes will have on future costs. The Blue Cross and Blue Shield Service Benefit Plan will keep you updated on health reform changes that affect you. We are committed to making coverage under the Service Benefit Plan as affordable as possible.

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FEHBP Enrollment and Eligibility Questions

Q:  Does the ACA allow all Americans to enroll in the Federal Employees Health Benefits Program (FEHBP)?
A:  No. The ACA does not allow everyone to get coverage through the FEHBP as it is an employer-sponsored plan.  The ACA allows the general public to enroll in the Health Insurance Marketplace, also known as health insurance exchanges. However, the ACA does allow certain tribal organizations to enroll their employees in the FEHBP. Those organizations that choose to enroll in the FEHBP and their employees must pay 100 percent of their premium with no government contribution.

Q:  Will I have to buy a new health plan if I already have health insurance through the Service Benefit Plan?
A:  No. We believe that any person who has coverage through the Service Benefit Plan meets the ACA requirement and will not be forced to buy another form of coverage.

Q:  Is there a scenario where the FEHBP and the Service Benefit Plan would end?
A:  The majority of changes in the ACA relate to the private health insurance coverage offered in the individual and small group market. The ACA has very little impact on the coverage offered through most large employers, including the federal government.  Ending the FEHBP would require congressional action.

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Health Insurance Marketplace (Exchange) Questions

Q:  If I want to opt out of the Service Benefit Plan in the FEHBP and enter the Health Insurance Marketplace, can I do so?
A:  You might be able to enroll in a Marketplace health plan, but you should not make a decision to leave the FEHBP until you have talked with your employing agency or OPM about important considerations. These include whether you would receive the government contribution, whether you would be eligible for a subsidy under the law, and whether you would be able to rejoin the FEHBP or continue FEHBP coverage in retirement. You should also consider key differences when choosing the right health plan for you and your family, such as coverage and provider networks.

Q:  Do members of Congress and their staff have to get coverage through the exchanges?
A:  A provision of the Affordable Care Act requires members of Congress and their official staff to enroll in the Marketplace (exchange) plans. OPM issued their final rule on September 30, 2013.

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Page last updated: October 18, 2013

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