Medicare vs FEHB Enrollment
As an active or retired Federal employee covered by both the Federal Employees Health Benefits (FEHB) Program and Medicare, you probably have had questions from time to time about how the two programs work together to provide you with your health benefits coverage. These pages contain answers to the questions we at the Office of Personnel Management are most frequently asked about FEHB and Medicare.
Q. What Are the New Provisions of Medicare?
A. Medicare has two new provisions: Part C (Medicare Advantage) and Part D (Medicare Prescription Drug Coverage).
Part C: You can enroll in a Medicare Advantage plan to get your Medicare benefits. Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries.
Part D: There is a monthly premium for Part D coverage. Most Federal employees do not need to enroll in the Medicare drug program, since all Federal Employees Health Benefits Program plans will have prescription drug benefits that are at least equal to the standard Medicare prescription drug coverage. Still, you may want to be aware of the benefits Medicare is offering, so you can help others make informed decisions. If you have limited savings and a low income, you may be eligible for Medicare's Low-Income Benefits. For people with limited income and resources, extra help in paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.ssa.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Medicare beneficiaries received information about these new choices this fall in Medicare & You, a reference handbook. Medicare's web site (www.medicare.gov) also has information on Medicare Advantage plans. You should contact your retirement system before making any change to your coverage, especially if you are considering suspending your FEHB coverage to enroll in a Medicare Advantage plan. If you are a CSRS or FERS annuitant, you may call OPM's Retirement Information Office at 1-88USOPMRET (1-888-767-6738) or (202) 606-0500 from the metropolitan Washington area, or you may write to:
Q. What Does Medicare Cover?
A. Original Medicare has four parts:
Medicare does not cover:
A. You are eligible for Medicare if you are age 65 or over. Also, certain younger disabled persons and
persons with permanent kidney failure (or End Stage Renal Disease) are eligible.
A. Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB
plans also provide coverage for prescription drugs, routine physicals, emergency care outside of the
United States and some preventive services Medicare doesn't cover. Some FEHB plans also
provide coverage for dental and vision care.
Q. Since I Have FEHB Coverage, Do I Need Medicare Coverage?
A. If you can get Part A premium-free, you should take it, even if you are still working. This will help
cover some of the costs your FEHB plan may not cover, such as deductibles, coinsurance, and
charges that exceed the plan's allowable charges. There are other advantages to enrolling in Part A,
such as being eligible to enroll in a Medicare Advantage plan.
Enrollment in Medicare Part D is voluntary and you must pay a monthly premium. For people with limited income and resources, extra help paying for a Medicare prescription plan is available. Information regarding this prpgram is available through the Social Security Administration online at www.socialsecurity.gov or call 1-800-325-0778.
Q. Can I Change My FEHB Enrollment When I Become Eligible for Medicare?
A. Yes, you may change your FEHB enrollment to any available plan or option at any time beginning on the 30th day before you become eligible for Medicare. You may use this enrollment change opportunity only once. You may also change your enrollment during the annual open season, or because of another event that permits enrollment changes (such as a change in family status).
A. Once Medicare becomes the primary payer, you may find that a lower cost FEHB plan is adequate for your needs, especially if you are currently enrolled in a plan's high option. Also, some plans waive deductibles, coinsurance, and copayments when Medicare is primary.
Q. I Want to Join a Medicare Advantage Plan. Should I Drop My FEHB Coverage?
A. When you enroll in a Medicare Advantage plan, you may not need FEHB coverage because the Medicare Advantage plan provides you with many of the same benefits. You should review their benefits carefully before making a decision. You should contact your retirement system to discuss suspension and reenrollment.
Q. Can I Reenroll in FEHB If I Disenroll From the Medicare Advantage Plan?
A. If you provide documentation to your retirement system that you are suspending your FEHB coverage
to enroll in a Medicare Advantage plan, you may reenroll in FEHB if you later lose or cancel your
Medicare Advantage plan coverage.
Q. How Can I Get More Information About Medicare?
A. During the fall of each year, you will receive a copy of the Medicare & You handbook, which is also
available by calling 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048. Other useful
publications, such as the Guide to Health Insurance for People with Medicare, are also available from
this toll-free number or from your State Health Insurance Assistance Program (SHIP) counseling office.
You can find SHIP counseling office telephone numbers in the Medicare & You handbook. Medicare
information and publications are also available on the Internet at www.medicare.gov. If you do not
have a personal computer, your local library or senior center may be able to help you access this