If you are covered by Federal Employee Health Benefits and become eligible for Medicare, you probably have questions regarding which coverage to take or if you can have both. Below, we review all possible scenarios for those on FEHB and Medicare. Thus, ensuring you have a clear understanding of how the two coverage types work together.
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Medicare vs. FEHB Coverage
FEHB is the world’s largest employer-sponsored group health insurance program. This coverage is for federal workers and retirees, as well as their families and spouses. Like Medicare, FEHB includes coverage for inpatient and outpatient services. So retired, former, and active federal employees who are eligible for both programs – as well as those who are eligible for FEHB through their current or former spouse – often wonder if they can have both Medicare and FEHB at the same time.
The short answer is yes. You can have Medicare and FEHB coverage simultaneously. But do you need both? Well, it can be beneficial. We’ll discuss how and why – please also check out our video or podcast below.
Listen to this Podcast Episode Now!Do You Need Both Medicare and Federal Employee Health Benefits?
Although most people who are eligible for Medicare and FEHB won’t need a Medicare Supplement or Medicare Part D plan, the truth is that FEHB can be expensive. Thus, these beneficiaries often ask if there’s a way to coordinate their coverage that will also minimize their out-of-pocket costs. With Medicare, there are a few ways to do this.
How Does FEHB Work With Medicare?
For those on FEHB and enrolling in Medicare, it is important to know that Medicare will always pay secondary to FEHB while you or your spouse are still employed. Although the coverage may look similar, often you will find that Medicare offers more extensive coverage for things like durable medical equipment, home health care, and prosthetic devices – to name a few.
FEHB With Medicare Part A
Those who have paid Medicare taxes for enough quarters are eligible to enroll in Medicare Part A, premium-free. Often, it is recommended that those who are eligible for premium-free Medicare Part A enroll in the coverage, even if they are still working. Although it will pay secondary to your FEHB, it is an earned benefit that you should take full advantage of.
FEHB With Medicare Part B
For Medicare Part B outpatient coverage, you’ll need to pay a monthly premium – no matter how many quarters you pay Medicare taxes. Additionally, you’ll still have to pay the FEHB premium. So, if you have FEHB, you can delay Medicare Part B for as long as you’re working and may save money by doing so.
When deciding whether to pick up Medicare Part B, calculate what you’d pay in Medicare Part B premiums for the year (higher-income earners are responsible for larger premiums). Then, calculate your best estimate for the dollar amount you’d need to pay in copayments for outpatient services on FEHB.
If you find that you would pay more in premiums, you’ll indeed save money by delaying Medicare Part B. Yet, those whose copays on FEHB in an average year outweigh their would-be Medicare Part B premiums should consider enrolling in Medicare Part B. Remember, once you enroll in Medicare Part A and Part B, Medicare will become your secondary coverage while FEHB acts as primary while you are still working.
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With this combination of coverage, you can see any practitioner who accepts Medicare and receive benefits through Medicare Part B that FEHB doesn’t provide.
FEHB With Medicare Part D
When you have FEHB, it is not necessary to enroll in Medicare Part D. Federal Employee Health Benefits covers prescription drugs at no additional cost, so having a Medicare Part D plan would not be beneficial.
Suspending FEHB for Medicare Plus Supplemental Coverage
If you have Original Medicare and FEHB but want coverage through a Medicare Advantage, you’ll need to suspend your FEHB coverage. Suspending FEHB is not the same as canceling. Meaning, you can re-enroll if you decide to suspend your FEHB. However, if you enroll in a Medicare Supplement plan, you will be required to cancel your FEHB.
Advantage plans, also known as Medicare Part C, become your primary coverage. Medicare pays the private insurance company offering the policy to take on the beneficiary’s risk. Most of these plans include dental, vision, hearing, and prescription drug coverage.
For as long as you suspend your FEHB, you won’t have the prescription drug coverage you used to receive.So, ensuring your Medicare Part C plan has drug benefits is crucial. If you choose to return to your FEHB plan, you can do so during Open Season.
If you choose a Medigap plan to go with your Medicare Part A and Part B coverage, you should also look for a Medicare Part D plan to cover prescription drugs, as a lack of creditable drug coverage will leave you vulnerable to a penalty.
FEHB Coverage After Retirement
It’s never mandatory to take Medicare – yet, there can be consequences to delaying enrollment. When you have FEHB, you’re safe from the Medicare Part B late enrollment penalty for as long as you or your spouse is actively working.
When you or your spouse retires, however, things get more complicated. Once you or your spouse stops working you will be granted a Special Enrollment Period. This will allow you 63 days from the time of the event to enroll in Medicare if you have delayed coverage. Otherwise, you’ll be subject to the late enrollment penalty whenever you enroll.
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As long as you keep FEHB, whether or not you’re working, your prescription drug coverage is sufficient, and you’ll avoid the late enrollment penalty for Medicare Part D.
Mail Handlers Insurance and Medicare
The Mail Handlers Benefit Plan (MHBP) has been serving federal and postal employees for over 50 years. Aetna administers the MHBP, whose plan options include Self Only, Self Plus One, and Self and Family – similar to FEHB.
It’s best to have MHBP and Medicare when you become Medicare-eligible. Medicare will be the primary insurance and MHBP will give you access to things Medicare doesn’t cover like additional options for chiropractic care.
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Dear medicarefaq.com owner, Your posts are always well-timed and relevant.
I have blue cross blue shield with federal insurance. And Medicare B Do I need Medicare B?
Hi Sharon, many folks who are in your shoes have the same question when it comes to FEHB and Medicare Part B. Ultimately, the decision is in your court. Medicare Part B is not necessary, however, if you decide to enroll in coverage later down the road, you will be required to pay the Part B penalty for each year you went without Part B coverage. I recommend comparing the benefits of your FEHB plan and Medicare Part B (with a Medigap or Medicare Advantage plan) and decide which option works best for your specific needs.
I have NALC Cigna CDHP through FEHP health insurance with the post office, I’ll be turning 65 yrs this July 2022 do l have to apply for Medicare Part B or is my health insurance is enough coverage.
Maria, if you are still employed, you can delay Medicare Part B coverage for FEHB. Once you retire, you will need to enroll in Medicare Part B to avoid the late enrollment penalty.
Turning 65 in 2022. I am retiring from government service. Why do you keep saying FEHB is not creditable coverage under Medicare? The way it looks to me we just need to keep our BCBS and just enroll in part A. We should be saving in retirement not spending more money on healthcare insurance.
If you are actively working and on FEHB, you can delay your part B. Once you retire, FEHB no longer serves as credible coverage. After retirement you must enroll in Part B to avoid the penalty. If you wish to keep your FEHB and only enroll in Part A, you can do so, however you will face a penalty if you decide to enroll in Part B in the future.
Is it possible to have medicate bcbs fehb and another option for younger spouse? Or do I have to choose only one?
Jeff, there should not be an issue adding secondary insurance, however you will want to be sure the two coverages work with one another. I recommend speaking with your FEHB plan administrator for clarification.
I will retire from Federal Service soon, and I also have a VA service-connected disability, so I can see doctors in a VA facility. Would it be wise to drop FEHB (wife will need to enroll in Medicare A&B plus an Advantage plan) and not get Medicare part B?
John, this is a tough decision to make. Your specific circumstances will be the deciding factor for which coverage best fits your needs. I recommend completing our online rate form and speaking with a licensed agent to help review your options.
I want to keep what I’ve had for the past few years
I am retiring next year. I have MHBP standard and medicare part A&B.
I am receiving information on the aetna advantage plan being offered by gov’t.
Not sure if I am giving up the MHBP in order to get the Aetna advantage plan? If not then will I be paying for 3 plans? MHBP,Aetna advantage and Medicare?
Hi David – Medicare Advantage stands in for Medicare Parts A and B. However, you will likely still need to pay your Part B premium in addition to the premium that comes with your Advantage plan, if applicable.
Here is my question from Nov 19.2021
I am a retired federal employee under the old Civil Service Pension Plan. I get minimal social security as I have over 40 quarters SS before going to work for the government. My net SS check is such that I don’t pay full amount for part B, so each year a COL is issued it is applied against my Part B premium. With that said, if I change to Medicare Advantage, will they apply the part B reduction cost to the Part Be premium or will I get that benefit in full?
Reply
Hi Norma – when you have a Medicare Advantage plan, you still must pay your Part B premium. Nothing should change in regards to your Part B premium unless you happen to enroll in an Advantage plan with a give back feature.
looking for my post
Hi Norma – your comments show up after we address them.
On 11/19/2021 I posted a question regarding Part B medicare payments. It has been removed without a reply. Can you pull it back please and give me a reply. Thank you
Hi Norma – I have looked through our removed comments and cannot find yours. We apologize for the inconvenience. Can you please restate your question?
I am a retired federal employee under the old Civil Service Pension Plan. I get minimal social security as I have over 40 quarters SS before going to work for the government. My net SS check is such that I don’t pay full amount for part B, so each year a COL is issued it is applied against my Part B premium. With that said, if I change to Medicare Advantage, will they apply the part B reduction cost to the Part Be premium or will I get that benefit in full?
Norma, The Medicare Part B reduction benefit is different through each carrier. Some will give the full amount and others will give you a partial return for your Part b premium. This is dependent upon what plans are available in your area.
I am turning 65 in August of 2022. I currently have BC/BS under FEHBA. If I elect to take Medicare part B and I go to a doctor that doesn’t take Medicare can I still get full coverage under my BC/BS plan?
Hi Tina, in this case, Medicare is primary. If you choose to go to a non-participating doctor, based on the coordination of benefits, the claim must be filled with the primary payer (Medicare) and then the secondary (FEHB). This means you could be responsible for 100% of the cost.
Why would I be responsible for 100%. So I pay for 2 insurances and still have to pay 100% ???
Hi Donna – this is in the case of the provider not accepting Medicare. If the provider doeesn’t accept your insurance, you could be responsible for paying the full amount.
Actually, we have this situation with our long-time family physician. He “opted out” of Medicare. Annually we file a copy of his Opt-Out letter with our FEHB insurance carrier (for us it’s been MailHandlers Benefit Plan/Aetna). If MHBP has a copy of the physician’s opt-out letter on file they assume primary responsibility and pay coverage per their plan for any services from this physician.
I am a federal retiree. My husband and I have both Medicare Part A and Part B as well as the highest option of BC/BS PPO which is now costing us over $600 a month. We pay nothing out of pocket for doctor visits, tests etc would we be better to reduce our coverage to BC/BS PPO other plan?
I feel we are over insured
Hi Jo Ann, if you both have Parts A and B, you do not need to be paying that much for additional coverage. You can drop your PPO and pick up a Medicare Supplement or Advantage plan for extra coverage.
I am currently enrolled in Medi care A and B plus FEHB retired in 2010 . I keep getting letters from Medicare advantage stating that it is better then FEHB , I currently pay no out of pocket for any medical bills I incur. Is Medicare advantage a better deal?
Hi Lucille! I would not say Medicare Advantage is better than FEHB. It would really depend on your location since Advantage plans vary from county to county. If you’re happy with your current FEHB, I would stick with them.
Iam a retired federal employee with FEHB BCBS coverage. Iam paying a late penalty on my part B. Why is my insurance not creditable under medicare, and have there been efforts in Congress to address t his rule .
Hi Don. You’re paying a penalty because FEHB is not considered creditable coverage. The coverage is not considered as good as Medicare coverage. At this time, there is no action in place from Congress to change this rule.
I am a retired federal employee that has Medicare Parts A and B. I also have a FEHB plan, Blue Cross Blue Shield Standard option. Should I change to the lower cost Blue Cross Blue Shield Basic option? Thank you for your assistance.
Tim, the right plan for you really depends on what your individual needs are. If you would like to speak with a licensed agent to review which coverage option is best for you, complete our online rate form.
Can a retired military / federal employee keep all 3 insurances: FEHB, Tricare for life, and Medicare (part A & B) simultaneously?
Hi Tabatha! No, you cannot keep all three. You either have FEHB + Medicare OR TRICARE for Life + Medicare.
Just turned 65 on Saturday, my wife is 9-years younger. I am two years in with the government, and plan to get my five years, for FEHB in retirement. You think this is a good plan. My wife can retire early and be covered by FEHB. I have friends say it not worth it. Looking for your input.
Hi John! FEHB + Medicare has a coordination of benefits that work really well with another. It pretty much leaves you with no out-of-pocket costs.
I am retired from the Postal Service with FEHB! I am turning 65 soon and have received material for medicare A and B. Am I automatically required to take medicare? Is it better and would I continue to have both! Is it beneficial to pay another 200 hundred a month for part B? Will I eventually be forced to take part B even though my FEHB are supposed to be for the rest of my life??
Hi Michael! You are not required to enroll in Medicare, but it’s recommended. FEHB is not considered creditable coverage under Part B if you’re not working, thus resulting in late enrollment penalties when you do enroll later. In addition, FEHB & Medicare have a coordination of benefits. The combination gives you great coverage.
So if my husband is a retired letter carrier age 70 and has FEHB but no Medicare B if he would now decide to suspend FEHB and take Medicare B he would pay a 50% penalty per month for the rest of his life?
Hi Marianne. Yes, that is the case since FEHB is not considered creditable coverage. The only way he could have the penalty removed is if he qualified for Medicaid due to being considered low-income.
My son has been on federal disability retirement and social security disability retirement and has been and still is covered through the NALC insurance under the FEHB. After two years he became eligible for Medicare A and B which he took as FEHB is not considered credible coverage. He is now losing his SSDI because he got a job and is making over $1300 per month; however, he will keep his federal disability as he will not make over 80% of the pay of the job he used to have. Medicare allows those previously on SSDI to keep Medicare A and B for 93 months, paying only for Part B; after that he would have to pay for A and B. Now that he will be off SSDI my question is: Is he required to keep paying for Part B for the rest of his life in order to avoid the Part B penalty when he takes Medicare at 65 or if he goes back on social security,
Hi Lynda, great question! Any penalties your son acquires between now and when he turns 65 will reset. When he ages into Medicare at 65, he will have no penalties. They will start to incur again if he delays enrolling after he turns 65.
I am getting mixed and confusing answers from Medicare customer service. I am retired and continue to have my FEHB Blue Cross Blue Shield coverage through OPM. My wife has always been and will continue to be covered by my FEHB BCBS insurance. She is now retiring. She will enroll for Medicare A, but it is my understanding that since she will continue to be covered by my FEHB BCBS, she will not need to apply for Medicare Part B. Is this correct?
Your wife is not required to enroll in Part B, however, FEHB is NOT considered creditable coverage under Medicare. This means, if your wife does not enroll in Part B as soon as she is eligible, she will have to pay a penalty the rest of her life when she does enroll later.
Lindsay – inquiring for my Mom who has both Medicare and MHBP coverages. A number of years ago around 2013 when Mom had to receive PT from a SNF Medicare was her primary provider and MHBP was secondary and her treatment extended beyond the 100% Medicare covered initial 20 days, the co-pay amount for days 21+ had been covered by MHBP. Unfortunately Mom has had another incident requiring SNF PT and I being told that MHBP no longer will cover the co-pay if her PT extends beyond the 20 Medicare covered days since Medicare is her primary coverage. Was there a change to the MHBP coverage of co-pays when Medicare is primary? Thank you
Hi Kevin! I don’t see any changes to the benefits, on page 14 you can see changes for 2021. It states that SNF is only covered for 40 days if MHBP is primary, but that is not a recent change. But that doesn’t mean it hasn’t changed since 2013. I would contact MHBP directly to find out what your options are.
I am a federal employee under FERS, age 62, planning to retire next year. My wife, covered under my FEHB plan, turns 65 later this year. Should she apply for Part A and/or Part B this year even though I am still working and we are covered by FEHB?
Hi Mike! Since Part A is premium-free, your wife should enroll. Regarding Part B, I would ask your benefits administrator to see if your wife is exempt from the late enrollment penalty since you are still working. I’m not sure how it works if the husband is still working but the wife is not. Normally, if you’re retired, you would need to enroll in Part B when you’re first eligible to avoid paying a late enrollment penalty later.
My BCBS Federal Employees Program will not be accepted come January 2021 at my hospital and most doctors. What should I do? Locate and sign up for a new insurance plan by December 14th?
Hi Jim! The Annual Enrollment Period ends December 7th. However, this enrollment period is for those who already have Medicare Advantage or Part D and want to make changes. If you don’t have Part B yet, you will get a Special Enrollment Period to enroll when you leave your FEHB plan. Once you enroll in Part B, you can then choose between enrolling in a Medigap plan or Medicare Advantage plan.
I am turning 65 in Jan 2021. My wife is 61. If I have Medicare Part A and B, I understand that my FEHB will become secondary coverage for me. Will the same FEHB insurance remain primary coverage for my wife?
Hi David! In theory, yes, but I would confirm with your benefits administrator.
How many retirees are covered under FEHB and what is the current average premium for a family plan?
Hi David! Unfortunately, we have no way of knowing how many retirees are currently covered under FEHB. Regarding premiums, they vary from state to state. According to FedSmith, the average monthly premium in Alaska for a family plan is around $400.