Government Retirement Plans
- Federal Employees
- State of California
- Ventura County
- CHAMPUS
- TRICARE
What is the Federal Employees Health Benefits (FEHB) Program?
The Federal Employees Health Benefits (FEHB) Program is a group health insurance program for Federal civilian employees, retirees, and their eligible family members.
The Federal Employees Health Benefits (FEHB) Program provides a wide selection of coverage options incuding:
- Fee for Service (FFS) plans
- Preferred Provider Organizations (PPO)
- Health Maintenance Organizations (HMO)
- High Deductible Plans that offer catastrophic risk protection
Go to http://www.opm.gov/insure/health/ to compare the costs, benefits, and features of different FEHB plans.
What Is FEHB Eligibility for Retirees and Survivor Annuitants?
Federal retirees and their surviving spouses may be eligible for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date of your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years).
For more information, contact the U.S. Office of Personnel Management at www.opm.gov/index.asp
What Is FEHB Eligibility for Dependents?
Dependent family members eligible for FEHB coverage are a Federal employee's spouse (including a valid common law marriage) and unmarried dependent children under age 22, including legally adopted children and recognized natural (born out of wedlock) children who meet certain dependency requirements. Stepchildren and foster children are included if they live with the Federal employee in a regular parent-child relationship. An unmarried dependent child age 22 or over who is incapable of self-support because of a mental or physical disability that existed before age 22 is also an eligible family member.
For more information, contact the U.S. Office of Personnel Management at www.opm.gov/index.asp
What Is FEHB Eligibility for Former Spouses?
Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.
For more information, contact the U.S. Office of Personnel Management at www.opm.gov/index.asp
Do FEHB Plans and Medicare Cover the Same Types of Expenses?
Plans under the FEHB Program generally help pay for the same types of expenses as Medicare. There are some services that FEHB may cover that Medicare does not, however, such as emergency care outside the United States and dental and vision services. Likewise, Medicare provides some coverage for orthopedic and prosthetic devices, durable medical equipment (DME), home health care, limited chiropractic services, and some medical supplies, which certain FEHB plans may not cover or only partially cover. Check your specific plan's evidence of coverage booklet for more details.
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If I Have FEHB Coverage, Do I Need Medicare Coverage?
If you are entitled to Part A without a premium, it is beneficial to enroll even if you are still working. Medicare Part A may help cover some your FEHB plan's deductibles, coinsurance, and costs that exceed the plan's allowable charges.
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, however, such as:
- If you have Medicare Parts A and B, you have the option of enrolling in a Medicare Advantage Plan.
- Medicare and your FEHB plan may coordinate to reduce your out-of-pocket costs.
- Your FEHB plan may waive its copayments, coinsurance, and deductibles for Part B services.
- Some services covered under Part B might not be covered or only partially covered by your FEHB plan.
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Can I Change My Retiree FEHB Plan When I Become Eligible for Medicare?
You may change your retiree FEHB plan to any available plan or option beginning 30 days before you become eligible for Medicare. 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. Some plans may waive deductibles, coinsurance, and copayments when Medicare is your primary insurer, as well.
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If I Want to Join a Medicare Advantage Plan, Should I Drop My FEHB Coverage?
If you enroll in a Medicare Advantage plan, you may not need retiree FEHB coverage because the Medicare Advantage plan will provide you with many of the same benefits. You should review the Medicare Advantage Plan benefits carefully before making a decision to suspend or cancel FEHB coverage. You should contact your retirement system to discuss benefit suspension and re-enrollment.
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Do I Need Medigap Coverage if I have FEHB?
You do not need to purchase a Medigap policy since FEHB and Medicare will coordinate benefits to provide comprehensive coverage for a wide range of medical expenses.
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