if i have fehb insurance why do i need medicare part b

For instance, with Medicare Part B, you’ll have access to coverage for durable medical equipment, such as wheelchairs, walkers, and oxygen pumps. In addition, your FEHB

will also coordinate with your Medicare benefits and this may reduce your out-of-pocket costs.

Full Answer

How does Medicare and FEHB work together?

FEHB and Medicare Enrollment Considerations. Generally, plans under the FEHB help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for routine physicals, emergency care outside of the United States and some preventive services that Medicare doesn’t cover (in addition, Medicare prescription drug coverage is ...

What is the maximum premium for Medicare Part B?

The standard monthly premium for Part B, which covers outpatient care and durable equipment ... or offers a different copay and an out-of-pocket maximum (a Medicare Advantage Plan). The Aduhelm situation highlights the ripple effect that expensive drugs ...

What are the rules for Medicare Part B?

Fact sheet FACT SHEET: Most Favored Nation Model for Medicare Part B Drugs and Biologicals Interim Final Rule with Comment Period

• Background. High drug prices are impacting the wallets of Medicare beneficiaries through increased premiums and out-of-pocket costs.
• Model Design
• Participants. ...

How much does Part B insurance cost?

Part B costs: What you pay 2021: Premium $170.10 each month (or higher depending on your income). The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services.

Do federal retirees need Medicare Part B FEHB?

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).

Do most federal retirees take Medicare Part B?

About 70% of federal retirees enroll in Part B, which means paying two premiums and in essence two duplicative insurance programs. A portion of the retirees that join Part B might do so as a hedge against the elimination of FEHB retiree benefits.

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.

Is FEHB creditable coverage for Medicare Part B?

Because all FEHB Program plans have as good or better coverage than Medicare, they are considered to offer “creditable coverage.” So, if you decide not to join a Medicare drug plan now, but change your mind later and you are still enrolled in FEHB, you can do so without paying a late enrollment penalty.

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?

Signing Up for Medicare If you are retired and receiving Social Security you will automatically be enrolled in Part A and B and should receive your Medicare card three months before your 65th birthday.

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.

Do you have to take 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.

Should I keep FEHB when I retire?

As a rule, at retirement you may keep your Federal Employees Health Benefits program coverage if you are currently enrolled and have been enrolled in the FEHB for at least five years or from your earliest opportunity to enroll. It makes no difference if you've bounced around from plan to plan.

What happens if I cancel Medicare Part B?

Late Enrollment Penalty for Part B The Part B late penalty is especially important to understand because it will stay with you the entire time that you have Medicare. The way the penalty works is that you pay a 10 percent increase for every 12-month period that you could have had Medicare coverage, but didn't.

Does FEHB have Medicare supplement plans?

However, FEHB plans and options will supplement Medicare by paying for costs not covered by Medicare, such as the required deductibles and coinsurance, and by providing additional benefits not provided under Medicare A and B, such as prescription drugs.

Can Medicare premiums be deducted from federal pension?

Frequently Asked Questions Retirement If you are not receiving social security benefits, you can have Medicare premiums withheld from your annuity payments. We must receive a request for the withholding from the Centers for Medicare and Medicaid Services.

What is the Federal Employee Health Benefits Program (FEHB)?

The FEHB provides comprehensive health insurance to federal retirees and their spouses. If you qualify for FEHB as a retiree, optional Medicare cov...

Are Medicare rules different if I have FEHB coverage?

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 p...

Will FEHB be my primary coverage? or Medicare?

If you have FEHB and do enroll in Medicare, then Medicare will be your primary coverage and your FEHB plan will pay after Medicare does. Having Med...

If I'm in the FEHB, should I enroll in Part A?

Most people don’t have to pay a premium for Part A. When combined with FEHB coverage, having Part A would limit your out-of-pocket costs for the ex...

Should I enroll in Part B if I have FEHB coverage?

Deciding whether to enroll in Part B is complicated. And unlike Medicare Part A, all enrollees pay a premium for Medicare Part B ($144.60/month in...

Will I pay less for FEHB premiums if I enroll in Medicare?

FEHB premiums are not reduced if you enroll in Medicare, but having Medicare Part A and B can allow you to switch to a less expensive version of yo...

When should I change my FEHB coverage?

You may want to make changes to your FEHB coverage when you are nearing Medicare eligibility, and will have the option to do this starting 30 days...

Should I suspend my FEHB cover to enroll in other coverage?

You can suspend your enrollment in FEHB to enroll in Medicare Advantage or other eligible coverage by contacting your agency’s retirement system, a...

What happens if I decline FEHB coverage?

If you decline FEHB coverage, you would give up the subsidy the government pays toward it, which ranges from a low of about $350 for self-only cove...

Should I enroll in Medicare Part D if I have FEHB coverage?

You generally don’t have to sign up for a Part D plan if you are covered through FEHB. The prescription coverage through your FEHB plan may have fe...

How much does it cost to join Part B?

For those who pay the higher part B income-tested premiums, this is a very considerable cost, at least $700 a year extra, and for some almost $6,000 extra to join Part B, depending on exact income level.

Do Part B plans cost extra?

Some plans cost very little extra for Part B, taking into account both premium and enhanced benefits. These are sometimes the plans that offer the best premium reimbursements, and sometimes not. What Federal Annuitants Need to Know About the FEHB Program and Medicare.

What is FEHB insurance?

The FEHB provides comprehensive health insurance to federal retirees and their spouses. If you qualify for FEHB as a retiree, optional Medicare coverage can lower your out-of-pocket costs, but you’ll have to pay a premium for this extra coverage. Back to top.

How long before you can change your FEHB coverage?

You may want to make changes to your FEHB coverage when you are nearing Medicare eligibility, and will have the option to do this starting 30 days before you qualify for Medicare. Changes can only be made once during this window. You can also wait until FEHB Open Season to change your coverage. Back to top.

What happens if you don't enroll in Medicare?

As a federal retiree, if you don’t enroll in Medicare, your FEHB plan will act as your primary insurer and won’t pay less because you qualify for Medicare.

What happens if you decline FEHB?

If you decline FEHB coverage, you would give up the subsidy the government pays toward it, which ranges from a low of about $350 for self-only coverage to $1,000 or more if you’re also covering family members. (These amounts are from premiums for federal employees other the Postal Service, which pays different rates.)

Is FEHB more generous than Medicare?

Although FEHB coverage can be more generous overall than Medicare Advantage or Original Medicare, having additional coverage may not be helpful if you can’t afford its premiums. If you qualify for the Medicare Savings Program (MSP) or Medicaid, you may find your healthcare costs are lower overall if you don’t use FEHB.

Can you suspend your Medicare Advantage plan?

You can suspend your enrollment in FEHB to enroll in Medicare Advantage or other eligible coverage by contacting your agency’s retirement system, and providing them documentation that you enrolled . If you do this , you’ll be allowed to leave your Medicare Advantage plan and return to FEHB.

Does FEHB cover dental?

Conversely, FEHB plans cover emergency care received outside the United States, and this isn’t covered by Original Medicare at all – and is rarely covered by Medicare Advantage. FEHB plans may also pay for vision and dental care that’s not covered by Original Medicare and is limited in Medicare Advantage.

What happens if you stay in FEHB and take Part B?

If you stay enrolled in FEHB and also take Part B: Medicare will be primary. FEHB may cover your Medicare cost-sharing (deductibles, copayments, coinsurances) If you stay enrolled in FEHB and do not enroll in Part B: Your FEHB plan will continue providing the same coverage it did when you were actively employed.

Is FEHB primary or secondary?

Federal Employee Health Benefits (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.

Does FEHB have HMO?

Remember, FEHB plans offer HMO and FFS options . FEHB HMO plans have networks of providers and facilities. FFS plans allow you to see any provider, but you may pay higher costs. You should also compare the costs and benefits of your FEHB drug coverage and Part D to decide which best suits your needs.

What percentage of Medicare pays for FEHB?

Medicare Part B pays 80 percent for covered services. When you use Part B along with an FEHB plan, your FEHB plan may cover the 20 percent you’d be responsible for with Part B alone.

What is FEHB insurance?

The Federal Employee Health Benefit (FEHB) program provides health insurance to federal employees and their dependents. Federal employers are eligible to keep FEHB after retirement. FEHBs can cover spouses and children up to age 26 even during retirement. FEHBs and Medicare can be used together to cover medical services.

How long do you have to be in FEHB to retire?

The second requirement is that you’ll need to have been enrolled in your current FEHB plan for at least 5 years or the entire period of time since you were first eligible to sign up. So, if you don’t start a federal job until later in your career, you can retire sooner than 5 years and still keep your FEHB plan.

How much is the Part B premium for 2021?

In 2021, the standard Part B premium is $148.50. Your premium will be higher if your income is over $88,000. You’ll pay this premium in addition to the premium of your FEHB plan if you use both together. Even though you’ll be paying two premiums, using FEHBs and Part B together is often a good choice.

What is Medicare Part A?

Medicare Part A is hospital coverage. It provides coverage for stays in the hospital or at long-term care facilities. As long as you’ve worked for at least 10 years and earned enough Social Security work credits, Part A will be premium-free. This means you’ll have an extra layer of coverage without needing to pay any additional premium.

How many health insurance options are there for federal employees?

The Federal Employee Health Benefit (FEHB) program includes over 276 health insurance choices for federal employees. While some plans are only available for employees in certain roles, such as the military, most federal employees will have multiple options to choose from. You also may be able to use both your Federal Employee Health Benefits ...

Does Medicare Advantage cover vision?

Medicare Advantage plans cover all the services of original Medicare and often add coverage for medications, vision care, dental care, and more. You might not need your FEHB plan if you choose to enroll in a Medicare Advantage plan. Since a Medicare Advantage plan takes the place of original Medicare and has more coverage, ...

What is Part B in Medicare?

Part B may provide coverage for goods and services for which FEHB give zero or limited coverage. Part B allows you to seek care any health care providers in the U.S. who accepts Medicare, while FEHB policies generally restrict you to a network of participating providers. Because Medicare coordinates benefits with FEHB, ...

How to compare Medicare Advantage plans?

If you’re considering enrolling in a Medicare Advantage plan or a Medicare prescription drug plan, you can compare plans online for free or over the phone with the help of a licensed insurance agent. Learn about the costs, coverage and benefits of plans that may be available in your area.

Is FEHB a Medicare Part A?

There is coordination of benefits between Medicare and FEHB, so the FEHB policy acts as supplemental coverage to Medicare Part A. If you wish to enroll in other types of Medicare coverage such as Medicare Advantage, Medicare Part D or Medigap, you will need to be enrolled in Part A.

Can you have both Medicare Advantage and Medicare Supplement at the same time?

Medigap plans and Medicare Advantage plans are very different, and you cannot have both types of policies at the same time.

Does Medicare Advantage cover prescriptions?

Medicare Advantage plans provide all of the same basic benefits as Medicare Part A and Part B, and most plans also cover prescription drugs, which Original Medicare doesn’t cover. Many Medicare Advantage plans may also offer routine dental, vision and hearing coverage.

Do you have to be enrolled in Part B or Part C for Medicare Advantage?

If you wish to join a Medicare Advantage (Medicare Part C) plan that offers dental or vision coverage (which are not always included in FEHB plans), you must be enrolled in Part B.

When does Medicare Part B start?

If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent ...

How long does it take for Part B to go up?

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 could have had Part B but didn't take it. You will pay the extra 10 percent for as long as you have Part B.

Do I have to take Medicare Part B?

Medicare Part B Coverage. Do I Have to Take Part B Coverage? 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.

Is orthopedic covered by Part B?

Some services covered under Part B might not be covered or only partially covered by your plan, such as orthopedic and prosthetic devices, durable medical equipment, home health care, and medical supplies (check your plan brochure for details).

Does FEHB waive coinsurance?

You have the advantage of coordination of benefits (described later) between Medicare and your FEHB plan, reducing your out-of-pocket costs. Your FEHB plan may waive its copayments, coinsurance, and deductibles for Part B services.

What is Medicare Part B?

Medicare Part B basically covers everything else, such as doctor visits, lab testing, surgery, physical therapy, chemotherapy, and durable medical equipment. If you or your spouse have worked at least 10 years in the United States, you have likely earned premium-free Part A.

How much does Medicare Part B cost?

Most people will pay $135.50 per month for Part B in 2019, although certain individuals with high incomes may pay more.

Can you suspend a FEHB plan?

Annuitants who enroll in a Medicare Advantage plan will suspend their FEHB plan. If you are interested in dropping your FEHB plan and enrolling in a Medicare Advantage plan, take the time to review your coverage details. Even though there are ways to re-enroll in an FEHB plan, you’ll want to be sure you’re making a smart move before going ...

Can you have both a FEHB and a Medicare Advantage?

With that said, having both an FEHB plan and a Medicare Advantage plan isn’t necessary. However, you do have the option in choosing Medicare over your FEHB plan. Medicare Advantage plans usually have very low monthly premiums, some even cost $0 a month. Keep in mind that in order to have a Medicare Advantage plan you must continue ...

Is Medicare Advantage the same as FEHB?

Additionally, Medicare Advantage plans usually offer many of the same benefits as FEHB plans do. With that said, having both an FEHB plan and a Medicare Advantage plan isn’t necessary.

Does FEHB cover wheelchairs?

For instance, with Medicare Part B, you’ll have access to coverage for durable medical equipment, such as wheelchairs, walkers, and oxygen pumps. In addition, your FEHB will also coordinat e with your Medicare benefits and this may reduce your out-of-pocket costs. Lastly, if you fail to enroll in Medicare Part B when you are first eligible, ...

Can you have a FEHB plan and a Medigap plan?

If you had both Original Medicare and an FEHB plan in retirement, your FEHB plan would supplement your Original Medicare . This makes it unnecessary to have an FEHB plan, Original Medicare, and a Medigap plan. However, again, you do have the option to choose Medicare over your FEHB plan.

How to contact Medicare for health insurance?

Other useful publications, such as the Guide to Health Insurance for People with Medicare, are also available at the Medicare number (1-800-633-4227) or from your State Health Insurance Assistance Program (SHIP) counseling office.

What is Medicare Advantage Part C?

Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries.

What is the difference between Medicare PPO and Medicare HMO?

Medicare HMOs – You must get your care from primary care doctors, specialists, or hospitals on the HMO's list of network providers, except in an emergency. Medicare PPO Plans – In most plans your share of plan costs is less when you use in-network primary care doctors, specialists and hospitals.

Is FEHB a lower cost plan?

Once Medicare becomes the primary payer, you may find that a lower cost FEHB plan is adequate for your needs, especially if you are currently enrolled in a plan's high option. Also, some plans waive deductibles, coinsurance, and copayments when Medicare is primary. I Want to Join a Medicare Advantage Plan.

Does FEHB cover coinsurance?

This may help cover some of the costs that your FEHB plan may not cover, such as deductibles, coinsurance, and charges that exceed the plan's allowable charges. There are other advantages to Part A, such as (if you also enroll in Part B,) being eligible to enroll in a Medicare Advantage Plan.

Does FEHB cover dental?

Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide . Some FEHB plans also provide coverage for dental and vision care.

Is FEHB better than Medicare?

Because all FEHB Program plans have as good or better coverage than Medicare, they are considered to offer creditable coverage. So, if you decide not to join a Medicare drug plan now, but change your mind later and you are still enrolled in FEHB, you can do so without paying a late enrollment penalty.

Medicare has different enrollment rules if you're a federal retiree

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).

Medicare Part B if you have FEHB coverage

You do not have to enroll in Part B if you don't want to, and you're not required by your FEHB plan to take it. However, some people choose to have both Part B and FEHB coverage.

Medicare Part A if you have FEHB coverage

The Office of Personnel Management (OPM), which administers the FEHB plans, recommends you take Part A if you don't have to pay a premium. This helps cover some of the costs the FEHB plans may not cover and limit your out-of-pocket expenses for services you receive.

Medicare Part D if you have FEHB coverage

If you have FEHB coverage, you typically don't have to enroll in a Part D plan. FEHB plans include prescription drug coverage, often with fewer restrictions than Medicare Part D plans. They also limit what you'll pay each year in covered prescription costs, so you may pay less than with a Part D plan.

Changing your FEHB coverage

You can make changes to your FEHB coverage beginning 30 days before qualifying for Medicare. Or, changes can be made during FEHB Open Season, which runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December each year.

Is Medicare or FEHB the primary payer?

The FEHB provides health insurance to federal retirees and their spouses. You have the option to choose from a few different types of plans, each covering medical services and supplies you may need.

When is Medicare the primary payer?

If you or your covered spouse are age 65 and have Medicare, it is the primary payer when you: