retired government employees who have career insurance do they have to go on medicare

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.

Full Answer

Can a federal employee have Medicare and retirement health insurance?

Federal Employee Retirement Health Benefits and Medicare. Beneficiaries eligible for FEHB and Medicare could enjoy having both types of insurance. The Federal Employee Health Benefits Program (FEHB) is for government employees and retirees. The FEHB is through the U.S. Office of Personnel Management for those who qualify.

What happens to my health insurance when I retire from federal government?

However, federal employees can keep their current federal employee health benefits (FEHB) plan upon retirement. Employees continue to pay the employee portion of the premium. The government pays the remainder of the retiree’s premium at the same rate as they do for current employees. (Up to 75% of the premium, depending on the plan).

Do I need Medicare Part B when I retire from government?

I will be retiring soon from my job in the federal government. I will continue to receive good health coverage from the Federal Employees Health Benefits Program (FEHB). So do I need Medicare Part B? En español | When you stop working, you don’t have to enroll in Medicare Part B if you don’t want to, and your FEHB plan can’t require you to.

What happens if you retire before you are eligible for Medicare?

Even after the passage of the Affordable Care Act, most people in the US receive their health care through their employer. Insurance can be difficult to obtain if you retire before you’re eligible before Medicare. The ability to have access to any sort of coverage between retirement and Medicare is a huge benefit.

Do retired federal employees have to enroll in Medicare?

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.

Do federal retirees with FEHB need Medicare Part B?

If you are working and have FEHB or you are covered under your spouse's group health insurance plan, then you do not have to enroll in Part B when you turn 65. You will have a special enrollment period when you retire or your spouse retires to enroll in Part B without paying a penalty.

Do federal employees have to take 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.

Are CSRS retirees covered by 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.

Do you really need Medicare and FEHB as a federal employee?

Yes, the vast majority of the time you are required to get on Medicare A and B at 65 if you are on Tricare even if you are also covered under FEHB or still working.

Do most federal retirees enroll in 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.

What happens to my federal health insurance when I turn 65?

If you are turning 65 years old and you are employed, your coverage continues unreduced.

Does Federal Blue Cross decrease when a retiree goes on 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 your current FEHB plan, because some FEHB insurers waive cost-sharing (like deductibles, co-pays and coinsurance) when you have Medicare Parts A and B.

Can federal employees have both FEHB and Medicare?

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.

Can I collect Social Security if I have a government pension?

Yes. There is nothing that precludes you from getting both a pension and Social Security benefits.

Can you get CSRS pension and Social Security?

The CSRS was a stand-alone government pension program whose annuities were never meant to supplement Social Security benefits. Hence, federal employees can receive both CSRS annuity and Social Security benefits.

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 ($171.10/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 is the same for active employees and retirees and...

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 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 ...

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 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 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.

When is Larry retired?

Larry retired from federal service on Jan. 3, 2019 and will become age 65 in July 2019. Larry is enrolled in FEHB and will be throughout his retirement. Larry needs to enroll in Medicare Parts A and B between April 1, 2019 and Oct. 31, 2019 in order to avoid paying a late enrollment penalty for Part B. Example 2.

How does Medicare work with my job-based health insurance when I stop working?

Once you stop working, Medicare will pay first and any retiree coverage or supplemental coverage that works with Medicare will pay second.

When & how do I sign up for Medicare?

You can sign up anytime while you (or your spouse) are still working and you have health insurance through that employer. You also have 8 months after you (or your spouse) stop working to sign up.

Do I need to get Medicare drug coverage (Part D)?

Prescription drug coverage that provides the same value to Medicare Part D. It could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance coverage.

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 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.

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.

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.

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.

Is FEHB covered by Medicare?

While FEHB plans cover most of the same types of expenses that Medicare covers, FEHB plans’ coverage may be more limited than Medicare Part B when it comes to orthopedic and prosthetic devices , durable medical equipment, home healthcare, medical supplies, and chiropractic care.

Can you pay Medicare excess?

Some states don’t allow excess Medicare charges. If you live in one of these states – or you see a doctor in any state that accepts Medicare’s rate as full payment – you’d only have to pay the difference between what Medicare and your FEHB plan pay and Medicare’s rate.

Can you reenroll in FEHB after the Advantage plan ends?

You can re-enroll in FEHB if this other coverage ends through no fault of your own.

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.

Understanding the Eligibility Rules for the Basic Medicare Options

While in federal service, every federal employee pays the Medicare Hospital Insurance Tax (HIT) payroll tax, equal to 1.45 percent of an employee’s salary (and matched by the employee’s agency).

Compare Investment Options for 2021

3 – Medicare Part C (Medicare Advantage, previously called Medicare Choice) are expanded health plan options (such as an HMO or PPO) approved by Medicare and offered by private companies that combine Part A and Part B in one network of health care providers. Medicare Advantage Plans are approved each year by Medicare.

How long can you keep health insurance after retirement?

OPM states that federal employees can keep their health insurance after retirement as long as you meet the following conditions: You retire on an immediate annuity or postponed retirement if you have reached your minimum retirement age and have 10 years of service.

What are the benefits of federal retirement?

Employees in the federal employee retirement system, also called FERS, receive three benefits. (1) A retirement annuity (pension). (2) A supplemental pension from ages 57-62.

How long do you have to be in FEHB before retiring?

In addition to MRA+10 you also must have participated in the FEHB for the 5 years prior to your retirement. If you retire with less than 5 years of service in the federal government, you may still be eligible to continue your FEHB if you were enrolled in FEHB for your whole government career.

How many years of service do you need to be a FEHB?

However, FEHB is governed by the “MRA+10 rule”. In general, you need to be at your MRA and have 10 years of service to be eligible. Note: you may be able to get a waiver in certain instances, please check the OPM guidance.

When do you have to enroll in Medicare Part B?

You’re expected to enroll in Medicare Part B when you turn 65 if you are retired. If you do not enroll at age 65, you will be penalized if you try to enroll later. You should know that while you can continue your FEHB benefits for life, your FEHB insurance company expects you to enroll in Medicare Part B.

How old do you have to be to get a full pension?

To receive a full pension, you need to have 30 years of federal service and meet your minimum retirement age (55-57 years old, depending on year of birth). You may also qualify for an immediate annuity at age 62 with 5 years of service or at age 60 with 20 years of service. However, FEHB is governed by the “MRA+10 rule”.

Does FEHB cover prescription drugs?

However, you may want to double check that your FEHB plan does cover the prescription drugs you need before declining Medicare Part D. If you decide you want Medicare Part D, you can add Medicare Part D during a future open enrollment period but may face a penalty in the form of an increased premium.

Can I change my health insurance coverage?

Yes. After you retire, you will still have the opportunity to change your enrollment from one plan to another during an annual open season. You cannot change to another plan simply because you retired. Each year, Open Season runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December.

Can I keep my health benefits after I retire?

Yes, you can keep your existing health benefits coverage if you meet all of the following conditions:

Can the eligibility requirements for continuing health benefits coverage be waived?

Yes. OPM has the authority to waive the 5-year participation requirement when it's against equity and good conscience not to allow an individual to participate in the health care insurance program as a retiree. However, the law says that a person's failure to meet the 5-year requirement must be due to exceptional circumstances.

Who is covered under my family health benefits coverage?

Your family enrollment covers yourself, your current spouse, your eligible children who are under the age of 26, and other eligible dependents.

What records are needed for my health benefits?

Your Official Personnel Folder should contain everything OPM needs, including a record of all of your health care benefits registration forms (SF-2809 and/or SF-2810). When you retire, you should make sure your records show a complete history of your health care insurance enrollment for the last 5 years.

What can I do if I'm eligible to continue my health benefits coverage, but my retirement payment will not cover the cost of my premium?

You can pay your premiums directly to OPM. You shouldn't send any payments until we contact you with instructions on how to pay your premiums to OPM.

How do I find out if I am eligible for Medicare coverage?

You should contact the Social Security Administration at least 3 months before your 65th birthday to apply for benefits. The Social Security Administration will have records pertaining to your eligibility for Medicare 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.

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.

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.

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).

What happens if you don't take Part B?

If you don't take Part B at first eligibility (at 65 if retired and not covered under a working spouse or new employer plan; or within 8 months of post 65 retirement or loss of coverage under a working spouse after 65) there is a 10% penalty on the current year premium added for each year you delay enrollment.

Does Medicare pay for FEHB?

The Original Medicare Plan pays its share and your supplemental FEHB coverage often pays the difference and if you carry both Part A and B most FEHB plans waive the deductible, copayments and coinsurance. Some things are not covered under Original Medicare, like prescription drugs.

What happens if you leave Medicare without a creditable coverage letter?

Without creditable coverage during the time you’ve been Medicare-eligible, you’ll incur late enrollment penalties. When you leave your group health coverage, the insurance carrier will mail you a creditable coverage letter. You’ll need to show this letter to Medicare to protect yourself from late penalties.

What happens if you don't have Part B insurance?

If you don’t, your employer’s group plan can refuse to pay your claims. Your insurance might cover claims even if you don’t have Part B, but we always recommend enrolling in Part B. Your carrier can change that at any time, with no warning, leaving you responsible for outpatient costs.

What is a Health Reimbursement Account?

Beneficiaries who participate can get tax-free reimbursements, including their Part B premium. A Health Reimbursement Account is a well-known Section 105 plan. An HRA reimburses eligible employees for their premiums, as well as other medical costs.

Is Medicare billed first or second?

If your employer has fewer than 20 employees, then Medicare becomes primary. This means Medicare is billed first, and your employer plan will be billed second. If you have small group insurance, it’s HIGHLY recommended that you enroll in both Parts A and B as soon as you’re eligible. If you don’t, your employer’s group plan can refuse ...

Is a $4,000 hospital deductible a creditable plan?

For your outpatient and medication insurance, a plan from an employer with over 20 employees is creditable coverage. This safeguards you from having to pay late enrollment penalties for Part B and Part D, ...

Is Part B premium free?

Since Part B is not premium-free like Part A is for most, you may wish to delay enrollment if you have group insurance. As stated above, the size of your employer determines whether your coverage will be considered creditable once you retire and are ready to enroll. Group coverage for employers with 20 or more employees is deemed creditable ...

Can employers contribute to Medicare premiums?

Medicare Premiums and Employer Contributions. Per CMS, it’s illegal for employers to contribute to Medica re premiums. The exception is employers who set up a 105 Reimbursement Plan for all employees. The reimbursement plan deducts money from the employees’ salaries to buy individual insurance policies.

Medicare vs. FEHB Coverage

Suspending FEHB For Medicare Plus Supplemental Coverage

FEHB Coverage After Retirement

• It’s never mandatory to take Medicare – yet, there can be consequences to delaying enrollment. When you have FEHB, you’re safe from the Medicare Part B late enrollment penaltyfor as long as you or your spouse is actively working. When you or your spouse retires, however, things get more complicated. Once you or your spouse stops working you will be...

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