Medicare Blog

how does it work if a federal retiree does not get medicare part b

by Miss Allison Aufderhar Published 2 years ago Updated 1 year ago

Some FEHB plans waive their own deductibles and copays for services that are also covered by Part B. If you don’t sign up for Part B when you retire, but need to do so at some future date — for example, if you lose FEHBP coverage or it becomes too expensive to maintain — you would be liable for Part B late penalties.

Federal Employee Health Benefits
Federal Employee Health Benefits
The Federal Employees Health Benefits (FEHB) Program is a system of "managed competition" through which employee health benefits are provided to civilian government employees and annuitants of the United States government.
https://en.wikipedia.org › wiki › Federal_Employees_Health_...
(FEHB) plans continue paying primary for retirees who do not enroll in Medicare Part B
. FEHB is only secondary if you enroll in Part B. Whether to enroll in Part B or use FEHB as primary coverage is a personal decision, based on your individual circumstances.

Full Answer

Should USPS retirees have to enroll in Medicare?

  • Medicare and FEHB Options - What Will You Do When You Turn 65? (Part 1)
  • A Marriage of Convenience – Medicare & FEHB
  • What to Consider Before Enrolling in Medicare B (Part 2)
  • Should You Change to a Lower Cost FEHB Plan When You Sign Up For Medicare (Part 3) Caution - Don't Lose Your FEHB Coverage

Should federal employees enroll in Medicare?

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.

Should veterans enroll in Medicare's Part B?

The VA usually encourages veterans to enroll in both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You typically don't have to pay a premium for Part A, while the standard Part B premium for 2019 is $135.50 or higher, depending on your income.

Do you really need Medicare Part B?

Medicare Part B isn’t a legal requirement, and you don’t need it in some situations. In general, if you’re eligible for Medicare and have creditable coverage, you can postpone Part B penalty-free. Creditable coverage includes the insurance provided to you or your spouse through work.

Is Medicare Part B required for federal retirees?

Most people who have retiree coverage must enroll in Medicare Part A and Part B when first eligible. If they don't enroll, their retiree plan may pay only a small amount – or nothing at all – for their care. Medicare's rules for you are different, however, if you're a federal retiree.

Do federal employees with FEHB need Medicare Part B?

You don't have to take Part B coverage if you don't want it, and your FEHB plan can't require you to take it. There are some advantages to enrolling in Part B: You must be enrolled in Parts A and B to join a Medicare Advantage plan.

Do feds need Medicare when they already have FEHB?

The answer: yes! FEHB coverage is comparable to Medicare coverage. Therefore, beneficiaries in the federal program may delay joining a Part D plan; likewise, they're exempt from any Part D late enrollment penalties. The federal employee plans often include prescription drug benefits, although drug coverage may vary.

Do retired federal employees pay for Medicare?

Most Federal employees and annuitants are entitled to Medicare Part A at age 65 without cost. When you don't have to pay premiums for Medicare Part A, it makes good sense to obtain coverage. It can reduce your out-of-pocket expenses as well as costs to FEHB, which can help keep FEHB premiums down.

What happens to my FEHB when I turn 65?

Your FEHB coverage will continue whether or not you enroll in Medicare. If you can get premium-free Part A coverage, we advise you to enroll in it. Most Federal employees and annuitants are entitled to Medicare Part A at age 65 without cost.

Are federal retirees automatically enrolled in Medicare?

Unlike most people with retiree coverage, who must enroll in Medicare Part A and Part B when they're first eligible, enrollment in Medicare is not mandatory if you have federal retiree coverage through the Federal Employee Health Benefits Program (FEHB).

How Medicare works with FEHB plans?

Since you are retired but covered under your working spouse's policy, your spouse's policy is your primary coverage. Medicare will pay secondary benefits and your FEHB plan will pay third.

Is Medicare Advantage better than FEHB?

Most MA plans are comparable to FEHB plans in hospital and medical benefits, but the prescription drug benefits will not be as good as in the FEHB program because the plans have a “coverage gap” where you are responsible for all or most drug costs until you reach a catastrophic limit.

What does Medicare Part B cover that FEHB does not?

Medicare may cover some services and supplies that some FEHB plans may not cover, including but not limited to: • Some orthopedic and prosthetic devices, and durable medical equipment; • home health care; • limited chiropractic supplies.

How do CSRS retirees pay for Medicare?

Those who chose to remain in CSRS are still not covered under Social Security and are not eligible for SS retirement benefits. But they do qualify for Medicare through taxes paid on federal earnings.

What is the cost of FEHB for retirees?

For retirees and non-postal employees in the largest FEHB plan, Blue Cross/Blue Shield standard, biweekly enrollee rates for self-only are increasing by $6.54 to $123.45, for self plus one by $13.66 to $280.81 and for family coverage by $13.38 to $300.12.

Can federal employees keep their health insurance when they retire?

Yes, you can keep your existing health benefits coverage if you meet all of the following conditions: You're enrolled in health care insurance under a federal plan when you retire.

How much is the penalty for not enrolling in Part B?

Because there is a 10 percent per year premium penalty for not enrolling in Part B within a few months of the deadline, annuitants are under great pressure to make a decision and about 70 percent decide to enroll. It can be surmised that this is usually an “everybody does it” rather than well-calculated decision.

Does Medicare Part B pay more than the standard premium?

Some of the Medicare Part B rebates will pay slightly more than the standard Part B premium, but none come close to matching the income- tested premium. Every family’s situation is unique, but for those subject to these higher premiums, the case for enrolling in Part B is far weaker under any of the four strategies.

Whether you should enroll in Medicare is based on federal law, not personal preference

If you already have health insurance when you turn 65, signing up for Medicare may seem redundant. Unfortunately, failing to enroll in Medicare Part B when you retire could leave you owing significant late penalties.

What Are the "Parts" of Medicare?

There are four "parts" to Medicare. Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Medicare Part A covers inpatient services received in a hospital or skilled nursing facility (SNF).

How Much Does Original Medicare Cost?

Like other types of health insurance, out-of-pocket Medicare costs include deductibles, premiums, and coinsurance or copayments. Costs for Parts C and D vary, because these are private insurance plans, meaning the insurer sets the rates.

Medicare Part B Costs

The standard Medicare Part B premium is $170.10 per month. You pay this amount even if you have a Medicare Advantage plan.

Should Federal Retirees Enroll in Medicare?

All federal employees have paid the Medicare tax since 1983, which means you qualify for premium-free Part A if you are a federal annuitant age 65 or older. We strongly encourage any federal employee age 65 or older to sign up for Medicare Part A as soon as they become eligible.

Who Pays First?

Medicare pays first once you retire. However, if you are a rehired annuitant or active federal employee, then your FEHB health plan pays first.

When Should You Enroll in Medicare?

If you're retired, you should sign up for Medicare as soon as you're eligible at age 65. This is known as your Initial Enrollment Period (IEP). It lasts for 7 months, beginning 3 months before your 65th birthday and ending 3 months after your birth month.

How many Medicare beneficiaries will pay less than the full Medicare premium?

An estimated 2 million Medicare beneficiaries will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory “hold harmless provision”, which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.

How much is Medicare Part B deductible?

The annual deductible for all Medicare Part B beneficiaries is $185 in 2019, an increase of $2 from the annual deductible $183 in 2018. Since 2007, a beneficiary’s Part B monthly premium is based on his or her MAGI.

How long does it take to change a FEHB plan?

Since enrolling in Medicare is considered a “life event”, an annuitant or employee can change his or her FEHB plan to any available plan or option at any time beginning 30 days before becoming eligible for Medicare and ending 30 days after the day the individual becomes eligible for Medicare.

What to do before retiring from federal health insurance?

Prior to retiring, federal employees should contact the benefits administrator or their FEHB insurer for information about their FEHB prescription coverage before making any changes. It is important to note that FEHB prescription drug coverage is an integral part of a federal employee’s total health benefits package.

When does a FEHB plan pay?

A FEHB plan must pay first when an individual is an active federal employee or rehired annuitant. When an individual is an annuitant and is enrolled in Medicare Parts A and B and in a FEHB plan, then Medicare is primary coverage and the FEHB is secondary coverage or Medicare supplement.

When is Medicare open season?

As long as the individual has FEHB coverage, they may enroll in a Medicare prescription drug plan from during the Medicare Part D “open season” (October 15 to December 7 of each year) at the regular monthly premium rate.

How long do you have to work to qualify for Medicare Part A?

Federal employees are eligible for Part A if they, or their spouse, worked in a Medicare Part A-covered employment for at least 10 years (40 credits), are 65 years or older, and are a citizen or permanent resident of the U.S. If an individual is eligible for Medicare Part A, then the individual and the individual’s spouse is automatically eligible ...

Can you cancel tricare for life?

Federal employees can’t suspend coverage; but, you can cancel and choose TRICARE For Life instead. And, if you lose TRICARE involuntarily, you can immediately re-enroll in FEHB. Further, if you choose to dis-enroll from TRICARE, you can still re-enroll in FEHB.

Is it mandatory to take Part B?

The Federal Health Benefits Program provides high-quality coverage. It’s not mandatory to take Part B when you have FEHB benefits, but you have the option. Upon retirement, individuals who delay enrolling in Part B face late enrollment penalties.

Can you forego Medicare Part D?

How the Federal Employee Health Benefits Program and Medicare Part D Works. You can forego Part D since the FEHB is creditable drug coverage. With your FEHB plan, drug benefits may be broad. You’ll want Part D coverage if your prescriptions aren’t on the FEHB formulary. Part D pays primarily for medications.

Can you suspend FEHB?

With that said, you may be able to suspend your FEHB. If you choose to return to your FEHB plan, you can re-enroll during Open Season.

Can you keep Medicare and FEHB?

Retired and active federal employees with FEHB and Medicare often wonder if they can keep both. The short answer is yes! FEHB benefits cover inpatient and outpatient services, just like Medicare, but each program is different. Here’s a breakdown of what both programs cover.

Can you enroll in Part B right away?

There are many benefits to enrolling in Part B right away. For example, several FEHB plans waive copayments and deductibles when you have Part B benefits. If you’re actively working, then the Part B penalties won’t apply to you.

Does Medicare pay for FEHB?

Medicare may pay for some services that your FEHB plan doesn’t cover, such as home health care, some medical equipment and supplies, and orthopedic or prosthetic devices. Your FEHB plan may pay for some services that Medicare doesn’t cover, such as annual physicals, routine dental and vision care, and emergency coverage outside of the United States.

Can you waive FEHB copays?

Some FEHB plans waive their own deductibles and copays for services that are also covered by Part B. If you don’t sign up for Part B when you retire, but need to do so at some future date — for example, if you lose FEHBP coverage or it becomes too expensive to maintain — you would be liable for Part B late penalties.

Key Takeaways

Federal workers enrolled in the Federal Employees Health Benefits Program (FEHBP) may want to delay taking Medicare Part B if you're still working past age 65. Most federal employees and retirees enrolled in FEHBP are not required to enroll into Medicare Part D since all FEHB plans offer prescription drug coverage as good as Medicare’s drug coverage. Activity duty and retired military personnel and veterans also have special considerations for how Medicare will work with TRICARE, TRICARE for Life, and veterans' health coverage..

What is the FICA Tax? And how does it relate to Medicare Part A?

The Federal Insurance Contributions Act or FICA payroll tax helps you earn credits toward Social Security, and helps to fund Medicare Part A and Social Security. Prior to 1983, federal government employees were exempt from contributing toward the Part A, or hospital insurance portion, of FICA.

Medicare & the Federal Employees Health Benefits Program (FEHBP)

Most federal employees participate in the Federal Employees Health Benefits Program (FEHBP), a type of federal health insurance available to non-military, federal government employees and retirees. FEHBP is administered through the Office of Personnel Management (OPM).

Expert Help to Understand Medicare Plan Options

Did you know that Medicare isn’t free, which means you need to consider plan coverage and prices before you enroll? Or that if you don’t enroll on time during your initial enrollment period, you could face a penalty? Navigating your Medicare selection needs and priorities may feel overwhelming.

How much does Medicare reimburse for a B plan?

Each member of a Basic Option plan who has Medicare Part A and Part B can get reimbursed up to $800 per year for paying their Medicare Part B premiums.

How does Medicare work with service benefit plan?

Combine your coverage to get more. Together, the Service Benefit Plan and Medicare can protect you from the high cost of medical care . Medicare works best with our coverage when Medicare Part A and Part B are your primary coverage. That means Medicare pays for your service first, and then we pay our portion.

What is Medicare for seniors?

What's Medicare? Medicare is a federal health insurance program for people age 65 or older, people under 65 who have certain disabilities and people of any age who have End-Stage Renal Disease. It has four parts that cover different healthcare services.

What is Medicare Part A and B?

Medicare Part A, B, C and D. The Original Medicare Plan (Medicare Part A & B) is available everywhere in the United States. It is the way everyone used to get Medicare benefits and is the way most people get their Medicare Part A and Part B benefits now. You may go to any doctor, specialist, or hospital that accepts Medicare.

How is Medicare Part B premium determined?

Medicare Part B premiums are determined by your Modified Adjusted Gross Income (MAGI). The more you earn the higher your Part B premium. For most beneficiaries, the government pays a substantial portion—about 75 percent—of the Part B premium, and the beneficiary pays the remaining 25 percent.

What happens if you only pick up Part A?

If you only pick up Part A your FEHB plan will remain your primary coverage for your medical Insurance including doctor's visits while Medicare A will be primary for your hospital coverage. If your spouse is under age 65 their primary provider will be your FEHB plan until they reach age 65.

How much does Medicare cost a month?

This is referred to as "premium-free Part A." If you must buy Part A, it will cost you up to $411 each month.

What is Medicare Advantage Part C?

Medicare Advantage is the term used to describe the various health plan choices available to Medicare beneficiaries. If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from ...

How to contact Medicare Advantage?

To learn more about enrolling in a Medicare Advantage plan, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or at www.medicare.gov. Part D (Medicare prescription drug coverage).

How many parts does Medicare have?

Medicare has four parts: Part A (Hospital Insurance). Most people do not have to pay for Part A. If you or your spouse worked for at least 10 years in Medicare-covered employment, you should be able to qualify for premium-free Part A insurance.

Medicare vs. FEHB Coverage

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Annuitants with adjusted gross income (AGI) of $88,000 or more (single) or $176,000 or more (married couple) will pay higher Part B premiums in 2021 and future years. How much higher depends on the AGI amount, but can rise to more than $500 a month, or more than $6,000 a year, per person. Even an income just b…
See more on myfederalretirement.com

Suspending FEHB For Medicare Plus Supplemental Coverage

FEHB Coverage After Retirement

Mail Handlers Insurance and Medicare

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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 bot…
See more on medicarefaq.com

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