There’s not enough data to determine the risk of long-term health effects caused by exposure to that kerosene-based aviation fuel, known as JP-5, according to the report, which was based on research conducted by the National Academies of Sciences, Engineering, and Medicine.

The authors did find “limited, suggestive evidence linking jet fuel exposure to short-term respiratory, gastrointestinal, skin and mental health symptoms,” which many military families experienced early on after the fuel leak.

The researchers cited the dearth of information and data about the detection, treatment and long-term effects of exposure to jet fuel in the 282-page report, titled “Clinical Follow-up and Care for Those Impacted by the JP-5 Releases at Red Hill.”

The research was sponsored by the departments of Defense and Veterans Affairs.

In a Thursday webinar, researchers said the limitation of data needs to be addressed so that long-term health effects can be better understood. They recommended various long-term research efforts.

Meanwhile, medical providers caring for people who were potentially exposed to the contaminated water should document exposure history, carefully evaluate and document symptoms and ensure continuity of primary care, the researchers recommended.

About 93,000 people were affected by the Navy’s two accidental releases of JP-5 in 2021. The fuel releases contaminated the drinking water supply for Joint Base Pearl Harbor-Hickam and the Aliamanu Military Reservation.

Immediately after the contamination, Navy officials told families it was OK to drink and bathe in the water. Some families experienced severe rashes, diarrhea and other gastrointestinal problems, as well as respiratory problems, mental health symptoms and other issues.

Military officials later gave families the choice of moving to hotels while the fuel was being flushed from the water distribution system and paid their expenses.

More than four years later, families continue to be concerned about their long-term health, including their children. Many babies were bathed in the contaminated water. Some people have had persistent, continuing symptoms. About 2,000 military families have filed lawsuits against the government alleging negligence and harm to their health.

There are no diagnostic or screening tests to determine past exposure, and there are no specific laboratory tests for detecting JP-5 in blood or urine. The report recommended research to develop and validate biological markers of petroleum associated with exposure to jet fuel, supported by the Centers for Disease Control and Prevention, National Institutes of Health, DOD and VA.

There are no known medical procedures that can detox or neutralize the effects of JP-5, the researchers stated.

In addition to their extensive review of available scientific evidence, the researchers visited Red Hill and the Honolulu Board of Water Supply and held 15 meetings with those affected in the community, including service members, military families, civilians and other Oahu residents. They also held additional in-person and virtual listening sessions.

A central theme that emerged from these community interactions was the breakdown of trust between residents and the medical system, researchers found. Families reported repeatedly trying to seek help for themselves and their children, while their conditions worsened.

Those individuals who were affected by the fuel leaks have been encouraged to sign up for registries, including the University of Hawaii Red Hill Independent Health Registry and, for the DOD population, the Red Hill Defense Occupational and Environmental Health Readiness System (DOEHRS) Registry.

But the researchers recommended that DOD link their Red Hill registry with patients’ electronic health records and claims data. Many in the mobile military community who were affected have relocated, and their electronic health record follows them.

Researchers recommended that DOD maintain this registry and expand it to include all individuals who lived or worked at Joint Base Pearl Harbor-Hickam or Aliamanu from May 6, 2021 to March 18, 2022.

Based on their review, the Academies researchers recommended other actions that could make a positive impact on the lives of people who are affected by these incidents in the future, such as developing a standardized environmental sampling and chemical analysis methods to test for petroleum contamination in drinking water.

“For military families, the event was experienced as a breach of trust, while for many civilians and Native Hawaiians, it confirmed enduring concerns about military activities and their impact on land and water,” the report stated.

“The contamination of drinking water at Red Hill stands as a defining environmental health event for Hawaii and for the nation,” the report continued. “It reveals how deeply the safety of water, the health of communities and the integrity of institutions are intertwined.

“For thousands of families the crisis raises serious questions about drinking water safety and breached trust with institutions.”

Those civilians, who aren’t eligible beneficiaries of military medical care, include a variety of people, from Department of Defense civilian employees to other civilians who received emergency and trauma treatment at any military treatment or clinic, both overseas and stateside, since June 21, 2023.

Military medical facilities can provide care to individuals who aren’t eligible beneficiaries in certain circumstances, by law, usually on a reimbursable basis. But the high cost of medical care was putting some of these civilians in financial distress. So Congress passed a provision in the 2023 National Defense Authorization Act that gave DOD the authority to protect patients from financial harm, to apply a sliding fee scale and catastrophic fee waiver.

The billing was paused in June 2023 in order for DOD to develop the new Military Health System Modified Payment and Waiver Program, to help these civilians who face financial difficulty.

Once the patient receives a medical bill, if they face financial harm, they are encouraged to apply for the program, officials stated in an email response to questions.

“We encourage all non-beneficiary civilians who received treatment in an MTF or clinic after June 21, 2023 to take full advantage of this program to see how much financial relief they may qualify for when they receive their bill,” officials stated.

While officials did not provide a timeline for the bills, a Feb. 6 Federal Register final rule implementing the program stated it became effective March 9. Information was not available about the estimated total amount of the billing. Each individual bill will vary and is determined by the length and type of treatment.

According to the Military Health System, if patients have other health insurance, the military hospital or clinic where they received care will file medical claims on their behalf. The patient will be responsible for copays, coinsurance, deductibles, nominal fees and non-covered services.

Those without health insurance will get a bill from the military hospital or clinic where they received care.

Each bill will include instructions on how to apply for financial relief through the program.

All complete applications will be evaluated based on the standards outlined in the final rule, applying a sliding fee scale and catastrophic waiver benefits, officials said. The final rule also guarantees flexible installment plans to allow patients to spread out their payments over up to 72 months.

The Federal Register rule outlines an initial process for determining the sliding fee discount and catastrophic fee waiver, using the Federal Poverty Guidelines. Those whose annual household income is at or below 100% of that year’s Federal Poverty Guidelines may receive a full discount on their bill; others receive discounts based on the sliding scale. Those federal guidelines are based on annual household income and family size.

For example, for those in the U.S., except for Alaska and Hawaii, a household of four people with an annual income of $32,150 would be at 100% of the federal poverty level in 2026.

Instructions for applying for financial relief are also available at the MPWP web page. Patients can also contact the Defense Health Agency’s Debt Adjudication office for assistance, Monday through Friday, 8 a.m. to 5 p.m. Central Standard Time at 210-295-3344, or by email at DHA-MPWP-Inquiries@health.mil.

According to an advanced Federal Register notice, the rescission will be effective immediately on publication, expected early Friday morning.

In the notice, VA officials said that while the rule was meant to clarify existing policy, “stakeholders have expressed uncertainty” about its impact on claims and leaving the rule in place during the codification process “could undermine confidence in the benefits system.”

“VA always takes veterans’ concerns seriously and recognizes that many commenters construed the interim final rule as something that could result in adverse consequences,” the notice read.

The rule, published Feb. 17, generated significant backlash from veterans, advocacy groups and lawmakers who said the proposal could have financially penalized veterans who adhere to medical treatment or encourage those seeking a disability rating to forego medications prior to a compensation and pension exam, putting their health at risk.

The VA said the regulation simply formalized a practice that has been in place since 1958. Officials said it was needed because a 2025 court ruling, Ingram v. Collins, decided the VA must discount the positive impact of medication when issuing a disability rating.

The rule stated that the methodology dictated by the courts set a standard that was “unquantifiable, hypothetical [and] unwarranted.”

The major veterans groups, including Disabled American Veterans, the Veterans of Foreign Wars and American Legion strongly objected to ruling, which they said was crafted without any input from veterans outside the VA.

Nearly 20,000 veterans and advocates have flooded the Federal Register’s comment section on the rule, saying it would hurt veterans.

“As a former Army nurse, it seems this rule change could have unforeseen and harmful downstream effects for veterans, which is why it demands serious public scrutiny and possible legislative clarification from Capitol Hill,” VFW National Commander Carol Whitmore said in a statement shortly after the rule was published. “While VA has authority to amend the rating schedule, it must do so without adversely affecting veterans.”

Collins announced two days after publication that the rule would not be enforced. But it remained on the books, raising concerns among veterans.

At least one lawsuit was filed against the VA seeking to stop implementation and on Tuesday, 20 Democrat and independent lawmakers from the House and Senate wrote Collins asking the rule be revoked.

They said that leaving the rule on the books was causing veterans to “confront the unnecessary dilemma of continuing life-improving treatment for their conditions.”

“This rule forces veterans into an impossible choice: follow their prescribed treatment plan or risk losing their benefits,” wrote the lawmakers, including the ranking Democrats on the House and Senate Veterans Affairs Committees, Rep. Mark Takano of California and Sen. Richard Blumenthal of Connecticut.

In letter, the lawmakers said enforcement of the rule could have resulted in an estimated $23 billion in savings and objected to what they said was a “political maneuver aimed at cutting costs.”

The VA has filed an appeal to the Ingram v. Collins ruling, and the rescission does not resolve that court case which continues.

In the notice to be published Friday, officials said the department is “committed to its mission of ensuring that every claimant applying for benefits — especially veterans who have earned disability compensation through their honorable service to the Nation — receives all benefits to which they are entitled under the law as expeditiously as possible.”

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Is the Medicare Part B late enrollment penalty statutory or regulatory?”

Kevin’s response:

The Part B late enrollment penalty can be found in the general and permanent laws of the United States, found here.

The specific location is Title 42 – The Public Health And Welfare, Chapter 7 – Social Security, Subchapter XVIII – Health Insurance For Aged and Disabled, Part B – Supplementary Medical Insurance Benefits for Aged and Disabled, Sec 1395r – Amount of Premiums for Individuals Enrolled Under This Part.

”…the monthly premium…shall be increased by 10 percent of the monthly premium so determined for each full 12 months (in the same continuous period of eligibility) in which he could have been but was not enrolled.”

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Are three two separate payments or two payments in one? I know there is a Part B payment, but didn’t know they attached a payment called IRMAA to the Part B payment.

Boy, this is rough on a retiree’s fixed income.”

Kevin’s response:

If you’re an individual tax filer and your modified adjusted gross income is above $103,000 or if you’re a joint tax filer with modified adjusted gross income above $206,000, you’ll be subject to an income related monthly adjustment amount, or IRMAA. In the first income tier of IRMAA, you’ll pay an additional $69.90/month for Part B and an additional $12.90/month for Part D. If you’re subject to IRMAA it will be added to the Part B premium.

Your choice of plans can help mitigate the additional Part B premium. Many, but not all, FEHB plans will eliminate out-of-pocket costs for doctor and outpatient services, and there are a couple of FEHB plans that offer a partial Part B premium reimbursement. Also, some MA plans offered by FEHB plans have $0 out-of-pocket costs for approved medical services from providers that accept Medicare and the plan, besides prescription drugs. Most of the MA plans offered by FEHB plans also include generous Part B premium reimbursement. The combination of $0 out-of-pocket costs (besides prescription drugs) and Part B premium reimbursement, help make MA plans offered by FEHB plans the lowest cost plan type for most federal annuitants.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“I have gotten conflicting and complicated information regarding does FEHB include/offer a Medicare Advantage option as a FEHB plan?

I have called OPM three times. Their advice is to call Medicare.

Medicare has no information on what plans are available to FEHB. Their advice is to call the plan. The plan says they do offer Medicare Advantage coordination, but it is offered with any plan, not a specific Medicare advantage plan (Aetna and BCBS), with some rebate of Part B premium and hoops regarding retiree services, etc., in an endless loop of ‘not my problem.’ Yet I see online where, since 2021, this has been an option.

It seems to be more clear cut for the Postal Service people, which I am not. I am on disability retirement and SSDI. Do you have any information regarding Medicare Advantage coordination with FEHB?”

Kevin’s response:

There are some FEHB plans that offer a Medicare Advantage plan to their Medicare eligible enrollees.

National plans include Aetna Advantage, APWU High, GEHA High and Standard, MHBP Standard, NALC High, and SAMBA High and Standard.

In addition, depending on where you live, you might have access to Kaiser or United Healthcare options.

To learn more about Medicare Advantage plans offered by FEHB plans, go to section 9 of the official FEHB plan brochure or to the carrier website.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

A Fed Times reader asks:

“My wife is covered on my “self+1″ Blue Cross FEHB plan. She will turn 65 this summer and will be going on Medicare Parts A and B. I am still 62 and will need to remain on the FEHB plan.

Is there some way I can change my FEHB enrollment to a “self only” plan at that time, or will I have to wait until open season in the fall?

Do I need to suspend her coverage as a spouse of an annuitant in order to preserve her ability to return to an FEHB plan if her new gap insurance doesn’t work for her needs?”

Reg’s response:

There is no provision in law or regulation that would allow you to suspend your wife’s FEHB coverage.

You could, of course switch to Self Only coverage; however, if you were to die before you were able to switch back, your wife would only be covered by Medicare A and B.

Got a question for the Federal Times expert? Send inquiries to: fedexperts@federaltimes.com.

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Am I to understand that Medicare is an integral part of retirement at age 65, even if a federal employee has an FEHB in retirement. Why is this?

Can the Medicare Part B be declined to avoid the high costs of the Part B premium and a potential IRMAA fee?Will the FEHB not be enough to cover all health care needs in retirement just as it did during active federal employee service?

Is there a comparison between having or not having Medicare Part B with an FEHB in retirement that one can distinguish to make a safe, informed decision on what to choose?The pros and cons, so to speak.”

Kevin’s response:

If you decide to not enroll in Medicare Part B, your FEHB plan will work the same way as it did as an active employee. You’ll continue to pay your FEHB plan member cost share for doctor and outpatient services.

There are three main reasons to consider enrolling in Part B.

1. Lower out-of-pocket costs – With Part B, many FEHB plans will waive out-of-pocket costs for doctor and outpatient services, and the deductible could also be waived, if your plan has one. Also, a couple of FEHB plans will reimburse a portion of the Part B premium.

2. Access to more doctors – With Part B you can go outside of your plan network and see any provider that accepts Medicare. You may be subject to the annual Part B deductible of $240 and 20% cost of service.

3. Medicare Advantage – Having Part B gives you the option to enroll in Medicare Advantage plans offered by FEHB plans. Some of these MA plans have $0 out-of-pocket costs for approved health care services from providers that accept Medicare and the plan, besides prescription drugs. Also, some MA plans will reimburse a portion of the Part B premium. The combination of $0 cost health care services (besides prescription drugs) and Part B premium reimbursement make MA plans offered by FEHB plans the lowest cost plan type for most federal annuitants.

The main reason to not consider enrolling in Part B is the cost of the extra premium. For federal annuitants that are not subject to IRMAA, adding Part B will most likely be worth it. Having Part B gives you the option to see doctors outside of the plan network and if you enroll in an FEHB plan that waives some out-of-pocket costs or consider MA plans offered by FEHB plans, you could see a reduction in your total healthcare spending.

For federal annuitants that are subject to IRMAA, most of the benefits of enrolling in Part B will erode by having to pay more. This is especially true if your income places you in the second tier or higher of IRMAA and you expect that level of income throughout your retirement.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“Do I have to enroll in Medicare Part A? Is there a penalty for failure to enroll when I decide to finally do?”

Kevin’s response:

If you or a spouse has worked for at least 10 years, Medicare Part A will be premium free. There is no advantage of delaying enrollment for premium free Part A.

Many FEHB plans will waive their in-patient hospital costs when Part A is primary. Also, being enrolled in at least Part A will qualify you to enroll in Part D prescription drug plans.

If you don’t have enough work credits to qualify for premium free Part A, you’ll have to buy Part A if you decide to enroll. If you don’t buy it when you’re first eligible to enroll, your monthly premium may go up 10%. Also, you’ll have to pay the penalty for twice the number of years you could have had Part A but didn’t sign up. For example, if you miss 2 years you’ll have to pay the higher premium for 4 years.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com

The question and response have been edited for clarity and confidentiality.

A Fed Times reader asks:

“I became a Federal Employee under the FERS retirement program in the fall of 2010. I retired from the reserves prior to becoming a federal employee. I am now receiving my retirement benefits from the reserves, which includes Tricare and have suspended my FEHB.

My spouse turns 65 next spring (2025) and I will turn 65 in the fall. I am aware that in order to receive Tricare for Life, one would need to purchase Medicare Part B.

I am wondering if I activate my FEHB, can I waive Medicare Part B and still maintain my Tricare coverage either as Tricare for Life or Tricare Select? I think it would be a cost savings since the FEHB plan (Blue Cross Blue Shield) for my spouse and I would cost less than each of us paying Medicare premiums plus the IRMAA additional premiums.”

Kevin’s response:

In order to qualify for Tricare for Life, you would need to enroll in Medicare Part B. However, retired reserve members at the age of 60 can instead choose to enroll in Tricare Select.

With Tricare Select, your FEHB plan would be primary and Tricare Select would be secondary. You wouldn’t need to enroll in Part B to be covered by an FEHB plan and Tricare Select. This would save you the cost of the Part B premium and having both FEHB and Tricare Select coverage will help you save on out-of-pocket healthcare costs.

Have a question about your FEHB plan or the federal insurance marketplace? Send your query to benefitsexpert@federaltimes.com