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Federal Employees' Health Benefits and Medicare

If you're a federal employee and you're planning to apply for Medicare, you'll want to examine how your Federal Employees Health Benefits (FEHB) and Medicare options complement one another.

Federal Employees Health Benefits

Unless your position with the federal government doesn't include health coverage, you and your spouse likely already have access to health plans through the Federal Employees Health Benefits (FEHB) Program.

As a FEHB beneficiary, your benefits include much of what Medicare covers: surgical and hospital care, prescription drug coverage and treatment for mental health issues and substance abuse problems. Some FEHB plans cover dental and vision care, as well as emergency care outside the United States. Medicare can cover equipment, home health care, services and supplies that FEHB plans only cover partially or not at all.

Ask your health plan carrier how your specific FEHB plan incorporates your Medicare coverage, which depends, in turn, on which managed care plan you choose: Medicare Advantage Plans or Original Medicare. You may qualify for:

  • Coordination of benefits
  • Reimbursement from Medicare for Part B services completed out of network
  • Waiving of co-payments, deductibles and co-insurance fees for Part B services by FEHB.

When is FEHB Your Primary Coverage?

As you consider your Medicare eligibility, note that Medicare and FEHB work well together in providing you with medical coverage.

If you're an active federal employee and you choose to continue to work past the age of 65, or if you're an employed annuitant with the government, FEHB remains your primary coverage.

Medicare is your primary coverage option if you're 65 years and older and:

  • A former federal employee
  • A retired federal judge or tax court judge
  • An annuitant
  • Enrolled only in Part B, regardless of your employment status.

How Will FEHB Affect My Prescription Drug Coverage Under Medicare?

Your Medicare prescription drug coverage does not change if you already receive FEHB coverage. FEHB is creditable drug coverage and usually pays at least as much as Medicare will for your drugs. Unless you qualify for extra help under Medicare, it may be best to stay with your FEHB drug coverage.

Along with reviewing Medicare restrictions and benefits, you may want to learn the basics of Medicare while mapping out how best to expand your FEHB benefits.

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