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Medicare and FEHB FAQs


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, 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 ( 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:

Office of Personnel Management
Retirement Operations Center
P.O. Box 45
Boyers, PA 16017-0045

Q. What Does Medicare Cover?

A. Original Medicare has four parts:

Part A (Hospital Insurance) helps pay for:

  • inpatient hospital care
  • skilled nursing facility care
  • home health care
  • hospice care

Part B (Medical Insurance) helps pay for:

  • doctors' services
  • outpatient hospital care
  • x-rays and laboratory tests
  • durable medical equipment and supplies
  • home health care (if you don't have Part A)
  • certain preventive care
  • limited ambulance transportation
  • other outpatient services
  • some other medical services Part A doesn't cover, such as physical and occupational therapy

Part C (Medicare Advantage Plans) provides all the benefits Medicare covers.

Part D (Medicare prescription drug coverage) helps pay for most prescription drugs, but most FEHB enrollees already have drug coverage as good or better than Part D.

Medicare does not cover:

  • Your monthly Part B premium ($88.50 in 2006)
  • deductibles, coinsurance or copayments when you get health care services
  • routine or yearly physical exams
  • custodial care (help with bathing, dressing, toileting, and eating) at home or in a nursing home
  • most dental care and dentures
  • routine foot care
  • hearing aids
  • routine eye care
  • health care you get while traveling outside of the United States (except under limited circumstances)
  • cosmetic surgery
  • some vaccinations
  • orthopedic shoes
Q. Am I Eligible for Medicare?

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.
You are entitled to Part A without having to pay premiums if you or your spouse worked for at least 10 years in Medicare-covered employment. (You automatically qualify if you were a Federal employee on January 1, 1983.) If you don't qualify for premium-free Part A, and you are age 65 or older, you may be able to buy it; contact the Social Security Administration.
You must pay premiums for Part B coverage, which are withheld from your monthly Social Security payment or your annuity.

Q. Do FEHB Plans and Medicare Cover the Same Types of Expenses?

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.
Medicare covers some orthopedic and prosthetic devices, durable medical equipment, home health care, limited chiropractic services, and medical supplies, which some FEHB plans may not cover or only partially cover (check your plan brochure for details).

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 B is voluntary and you must pay a premium. You can sign up for Part B during the seven-month Initial Enrollment Period, which begins three months before the month you turn 65 and ends three months after the month in which you
turn age 65.
If you do not sign up for Medicare Part B during your Initial Enrollment Period, you may sign up during any subsequent General Enrollment Period, which is January through March of each year. Coverage is effective July 1. However, your Medicare premium will be increased by 10% for each 12-month period you could have had Medicare Part B but did not take it, and you will have to pay a premium that is this percentage amount higher than the base Medicare premium for the rest of the time you have Medicare Part B.
There is one exception. If you don't sign up for Medicare Part B when you first become eligible because you or your spouse are still working and you are covered by an employer or union sponsored plan based on this employment, you are in a Special Enrollment Period and may sign up for Medicare Part B without an increase in your premium:

  • at any time while you are still covered by you or your spouse's employer or union group health plan based upon you or your spouse's current or active employment, and
  • during the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends, whichever is first.

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 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.
If you voluntarily cancel your Medicare Advantage plan coverage, you must wait until the next open season to reenroll in FEHB. If you involuntarily lose your coverage under the Medicare Advantage plan, you don't have to wait until the open season to reenroll in FEHB. You may reenroll from 31 days before to 60 days after you lose the Medicare managed care plan coverage, and your reenrollment in FEHB will be made effective the day after the Medicare Advantage plan coverage ends. An involuntary loss of coverage includes the Medicare Advantage plan being discontinued or when you move outside its service area.

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 If you do not have a personal computer, your local library or senior center may be able to help you access this website.
Your FEHB plan brochure provides specific information on how its benefits are coordinated with Medicare. Some HMOs participating in the FEHB will coordinate to your greater advantage if you enroll in both their FEHB HMO and their Medicare Advantage plan.