Life begins at 65. And if you figured out that at age 65 you have lived 780 months you probably also figured out that you are now eligible for Medicare. But what if you have FEHB. Should you still sign up? The decision to sign up is voluntary during specific enrollment periods. If you don’t sign up when you are first eligible, you may have to pay a late enrollment penalty. You first become eligible for Medicare Part A and/or Part B during the 7-month Initial Enrollment Period. If you’re eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65 (or 777 months old), includes the month you turn 65, and ends 3 months after the month you turn 65 (or 783 months old).
If you do not apply for one or more parts of Medicare, you can still be covered under the FEHB program. Your FEHB premiums will not be reduced if you enroll in Medicare. The cost will not change even when Medicare becomes the primary payer. Currently, they will remain the same unless you change to another plan or option.
Medicare:
Medicare is our country’s health insurance program for people who are:
- 65 years of age or older;
- Under 65 years with certain disabilities, such as, amyotrophic lateral sclerosis (Lou Gehrig’s disease); and
- Any age with end stage renal disease (permanent kidney failure requiring dialysis or a transplant).
The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.
Different types of Medicare plans help pay for different types of coverage, depending on the plan or plans you choose. Medicare has 4 parts.
Part A: Hospital Insurance. Helps pay for medically necessary inpatient hospital care, inpatient care in a skilled nursing facility, home healthcare and hospice care. Thanks in part to all the payroll taxes you paid while employed, you likely won’t have to pay a monthly premium for Medicare Part A. However, there will be a yearly deductible. Part A pays about 80 percent of your Medicare-approved costs. For 2014, the deductible is $1,216 for the first 60 days of hospital care and a daily coinsurance amount (approx. $304/daily) for hospital care each day from the 61st day up to a 150 day admission. But Free is Free. If you are entitled to part A without paying the premiums why wouldn’t you take it? Even if you are still working. It will help cover some of the out-of-pocket costs your FEHB plan doesn’t. Such as:
- Deductible
- Coinsurance and
- Charges that exceed the plan’s allowable charges.
Medicare also generally does not cover inpatient hospital care received outside the U.S.
Part B: Medical Insurance: Helps pay for medically necessary doctor’s services, outpatient hospital services and a number of other medical service and supplies that are not covered by Part A. Most people pay monthly for Part B. For 2014, the cost is $104.90 each month with a deductible of $147 per year. Medicare Part B pays 80% of most approved physician charges after you pay the annual deductible. Current law requires some individuals to pay a higher amount for Parts B and D based on their income. Word of caution: If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent for each 12 months that you were eligible for Part B coverage. You will pay that extra premium for as long as you have Part B. However, if you didn’t take Part B at age 65 because you were covered under FEHB as an active employee, you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working. Your FEHB coverage will be your primary coverage until you retire.
The following chart shows when your Medicare Part B becomes effective:
| If you enroll in this month of your initial enrollment period: | Then your Part B Medicare coverage starts: |
| One to three months before you reach age 65 | The month you reach age 65 |
| The month you reach age 65 | One month after the month you reach age 65 |
| One month after you reach age 65 | Two months after the month of enrollment |
| Two or three months after you reach age 65 | Three months after the month of enrollment |
Part C: Medicare Advantage/Your Private Insurance Plan. Covers all Medicare Part A and Part B services and allows individuals with Medicare Parts A and B to get Medicare benefits through private healthcare plans. Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries. You may choose to enroll in and get your Medicare benefits from a Medicare managed plan. These plans are generally organized as HMOs or PPOs. In most of these plans, you may go to doctors, specialists, or hospitals that are part of the plan. Medicare managed plans provide all the benefits that Original Medicare covers. Some cover extras, like vision and dental care. Most, but not all, Medicare Advantage plans also provide some prescription drug coverage.
Medicare D: Medicare prescription drug coverage. The newest addition to Medicare offers prescription drug coverage for individuals entitled to benefits under Part A or enrolled in Part B. You will pay a monthly premium and sometimes a deductible, as well as copayments for your drugs. Most Federal employees do not need to enroll in the Medicare drug program, since FEHB and Medicare will coordinate benefits to provide comprehensive coverage for a wide range of medical expenses.
Medicare doesn’t cover all the care you might possibly need. Each part of Medicare has exclusions. What’s not covered by Original Medicare are:
- Your monthly Part B premium or Part C or Part D premiums
- Deductibles, coinsurance or copayments when you get health care services
- Outpatient prescription drugs unless enrolled in a Part C plan which provides drug coverage or a Part D plan
- Most dental care or dentures
- Routine or yearly physical exams
- Routine eye care
- Routine hearing tests or hearing aids
- Most care while traveling outside the US
- Long-term care
- Custodial care (help with bathing, dressing, eating, etc)
- Cosmetic surgery
- Most chiropractic services
- Routine foot care or orthopedic shoes
- Acupuncture
So who pays first?
Medicare law and regulations determine whether Medicare or FEHB is primary. As stated earlier, Your FEHB coverage will be your primary coverage until you retire. Your FEHB plan must also pay benefits first, regardless of your employment status, due to End Stage Renal Disease (ESRD). Unless Medicare was your primary payer on the day before you became eligible for Medicare Part A due to ESRD.
When you or your covered spouse are age 65 or older and have Medicare and you:
Have FEHB coverage on your own or through your spouse who is an active employee or a reemployed annuitant and your position is not excluded from the FEHB – FEHB is the primary payer
Have FEHB coverage on your own as an annuitant or through your spouse who is an annuitant or are a reemployed annuitant and your position is excluded from the FEHB – Medicare is the primary payer
Are enrolled in Part B only, regardless of your employment status – Medicare is responsible for Part B services and FEHB for other services
When you or a covered family member are eligible for Medicare solely due to disability and you:
Have FEHB coverage on your own or through your spouse who is an active employee or a reemployed annuitant and your position is not excluded from the FEHB – FEHB is the primary payer
Have FEHB coverage on your own as an annuitant or through your spouse who is an annuitant or are a reemployed annuitant and your position is excluded from the FEHB – Medicare is the primary payer
TRICARE:
TRICARE is the health care program for service members (active, Guard/Reserve, retired) and their families around the world. TRICARE is a major part of the Military Health System that:
- Combines the resources of military hospitals and clinics with civilian health care networks
- Provides access to high-quality health care
- Supports military operations
For retired military or military spouses who want to find out how your retiree coverage works with Medicare, you should obtain a copy of your plan’s benefit booklet, or look at the summary plan description. You can also call your benefits administrator and ask how the plan pays when you have Medicare.
FOR MORE INFORMATION:
The SHINE program provides free, unbiased and up-to-date health insurance information, counseling and assistance to Medicare beneficiaries of all ages and their caregivers. The SHINE counselors help older persons (and younger disabled Medicare beneficiaries) understand their Medicare benefits and other health insurance options. https://shipnpr.shiptalk.org
To help you further understand your FEHB and Medicare please contact: www.fepblue.org/contact/customer-service/local-plan.jsp to find the resources in your area.
TRICARE information can be found at: http://tricare.mil//.
Regardless of the plan you use, contact the plan provider and ask how your FEHB Plan works with Medicare. You should be able to find contact information on your insurance card or plan’s benefit booklet.
Sources:
Medicare.gov
OPM.gov/insure
Socialsecurity.gov
BC/BS Federal Employee Program
