We encounter many federal employees doubting if they should, or even can, enroll in the Medicare program. Will you lose your Federal Employee Health Benefits (FEHB) if you enroll in Medicare? Do you really need Medicare if you have FEHB? Let us put your mind at ease. Even as a federal employee you are still eligible to enroll in the Medicare program…and we highly recommend that you do! There are still some decisions you need to make, though, because things can get complicated fast.
Medicare Basics
Before we get to the complex mumbo jumbo, let’s go over the basics of Medicare. For those of you who know the Medicare ABC’s, go ahead and skip to the next section.
Let’s start off by asking: when can you get your Medicare coverage?
You’re eligible for Medicare coverage when you turn 65. It’s highly recommended that you enroll three months before your birthday so that you can receive that coverage on the month that you turn 65. For those of you who are enrolled in the Social Security Disability program, you are automatically enrolled in the Medicare program and will receive your Medicare cards the month of your birthday.
Now that it’s established when you can get Medicare coverage, let’s go over what specific types of Medicare plans are available and what they cover.
There are 4 parts of Medicare: Parts A, B, C and D.
- Part A covers hospitalization care.
- Part B covers doctor and outpatient care.
- Part C is the Medicare Advantage Plan and covers the same as parts A and B.
- Part D covers prescription drugs.
Moving forward, let’s see how each of these plans will work with your Federal Employee Health Benefits plan.
Parts A and B
Parts A and B of Medicare, also known as Original Medicare, is the most common plan among members because it’s available everywhere in the United States. This type of plan can function smoothly with your FEHB because Medicare covers some of the costs that Federal Employee Health Benefits simply can’t. Here are some examples of what Medicare can cover:
- Deductibles
- Coinsurance
- Charges that exceed the plans allowable charges
- Orthopedic and prosthetic devices
- Durable medical equipment
- Home health care
- Limited chiropractic services
- Some medical supplies
While those items and services listed above are completely covered by Medicare, they can get a bit spotty on coverage when it comes to FEHB.
Part A is free to those eligible, so there should be no hesitation in enrolling in that plan.
Part B, on the other hand, isn’t mandatory. However, if you do choose to enroll, you’re entitled to a huge perk. Part B has a premium that you must pay monthly, right? Well, when you have both Part B and your Federal Employee Health Benefits plan, they work together to pay for your coverage. This ends up cutting your out of pocket costs tremendously. So why wouldn’t you enroll in part B when you can also keep your FEHB to make both plans work for you?
If you do decide that Plan B is just not something that will work for you… kiss your chances of getting Part C goodbye, as you must first have Part A and B to enroll.
Part C
Part C of Medicare, also known as Medicare Advantage, offers private-sector health coverage such as HMO’s and PPO’s. These plans are less expensive than the advantage plans your FEHB can offer which is why many people may want to change over to this plan.
But if you do get the Part C, you might consider dropping your Federal Employee Health Benefits plan, right? Most online Medicare resources clearly state that you should suspend your coverage instead of dropping it. These sources also say that you can try Part C and if you don’t like it you can enroll back into your FEHB.
Well this is where the phrase ‘don’t believe everything you read on the internet’ comes into play.
In our 15 years of experience it’s become clear that it is very difficult to retrieve your FEHB plan once it’s been dropped for Part C. We strongly advise you not to suspend or drop your Federal Employee Health Benefits plan for Part C. You can get the same coverage through Parts A and B, just subtract the private health sector.
It may be hard to believe but trust us when we tell you that losing FEHB coverage for Part C is not worth it. Just keep your FEHB and add on Part A and B.
Prescription Drug Coverage
Part D of Medicare is Prescription Drug coverage. This plan will cover all prescription drug medicine and is optional. Part D also has a monthly premium which, as of 2019, is around $34.
Some folks may want to add onto this plan but because they think it’s only $34. However, you don’t necessarily need to add on to Part D because you have FEHB coverage and it is a creditable prescription drug coverage plan (meaning it equals Medicare coverage). This is why Federal employees most likely won’t enroll in the Medicare Part D plan. The Federal Employee Health Benefits plan includes an excellent prescription drug coverage plan. Therefore, if you choose not to enroll in Part D you wouldn’t really be missing out on too much.
We know that navigating Medicare with your Federal Employee Health Benefits can be tricky. The last thing you want is to make an uninformed decision that costs you extra money, limits your coverage, or both! Contact a licensed representative today to start discussing the best options for you.