Fehb for Retirees: A Comprehensive Guide

As a retiree, you're likely eligible for FEHB, a valuable health insurance benefit that can help you stay healthy and financially secure in your golden years. You can enroll in FEHB during your initial retirement enrollment period, which typically occurs when you first retire.

FEHB plans are offered by various insurance companies, and you can choose from a range of options to suit your needs. The cost of FEHB plans varies depending on the plan and your location.

One of the key benefits of FEHB is that it provides comprehensive coverage, including doctor visits, hospital stays, and prescription medication. You can also add dental and vision coverage to your plan.

The Federal Employees Health Benefits (FEHB) Program is a comprehensive health care coverage for federal employees, annuitants, and their families. It offers a wide selection of plans to choose from.

You can choose from Consumer-Driven and High Deductible plans, Fee-for-Service (FFS) plans, Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO). There's even a Self-Plus-One option available.

Each year, there's an open season for participants to review and choose other plans if desired. This is a great opportunity to reassess your health care needs and adjust your coverage accordingly.

Starting in 2025, the Postal Service Health Benefits (PSHB) Program will replace FEHB coverage for eligible Postal Service employees, Postal Service annuitants, and their eligible family members. This new plan requires those under a certain age to sign up for Medicare Part B to retain their health care coverage in retirement.

As a retiree, you have the option to pick up FEHB and then suspend it right before retirement, allowing you to keep it in your back pocket for future use. This is a smart move if TRICARE doesn't cover a specific health care need or procedure.

TRICARE qualifies for the 5-year rule, which means you can reenroll in FEHB in the future without paying premiums.

You have a few options to consider when it comes to FEHB in retirement. One option is to keep your FEHB coverage with Medicare Part B, which can be a good choice if you have ongoing medical expenses.

You can also keep your FEHB coverage without Medicare Part B, but this may not be the most cost-effective option.

There are four main options to consider at retirement: Keep FEHB with Part B, Keep FEHB with no Part B, FEHB Advantage with Part B, or Suspend FEHB and enroll in Part B & Advantage Plan.

Here are the options in more detail:

If you're considering suspending your FEHB coverage, be aware that you won't be able to reenroll in the future if you cancel your enrollment as an annuitant. However, if you suspend your coverage because you're now covered by TRICARE, CHAMPVA, Medicaid, or a similar State-sponsored medical assistance program, you can restart your FEHB coverage in the future.

To be eligible for FEHB coverage in retirement, you must have been enrolled in the program for the 5 years immediately preceding your retirement. This rule applies to most federal employees, but there's an important exception.

If you're married to a federal employee, you're exempt from the 5-year rule, and can keep your coverage even if you weren't enrolled in FEHB for the full 5 years. This can be a big relief for couples who didn't know about the rule.

Choosing a Plan can be overwhelming, especially for retirees who are used to a different type of health insurance. You can choose from managed fee for service (FFS) plans, prepaid plans, or plans offering a point of service (POS) product and health maintenance organizations (HMO).

Managed care features are common in all the plans, including pre-approval of hospital stays, primary care providers as “gatekeepers” to coordinate your medical care, and networks of physicians and other providers.

Prepaid plans, on the other hand, pre-fund your covered health services with your premium and the government’s contribution. You must usually use specified plan physicians, hospitals, and other providers at designated locations, although care elsewhere may be available after a referral.

FFS plans reimburse you or your physician or hospital for covered services, allowing you to choose your own physicians, hospitals, and other health care providers without a referral. Some FFS plans are open to all enrollees, while others require you to join the organization that sponsors the plan.

If you're considering a plan with a point of service (POS) product, be aware that it may have rules about doctor choice and access to specialists, but you can choose any doctor you like and see specialists without referrals if you agree to pay more.

Here are some key plan types to consider:

In addition to these plan types, you may also want to consider consumer-driven options, high-deductible health plans, or Medicare-sponsored coordinated care plans.

Medicare and FEHB can be coordinated to provide comprehensive coverage in retirement. If you have both Medicare and FEHB, Medicare will pay first and FEHB will become secondary.

If you're an annuitant, you can suspend your FEHB enrollment if you're now covered by Medicare, TRICARE, CHAMPVA, Medicaid, or a similar State-sponsored medical assistance program, or Peace Corps Volunteer coverage. This will allow you to restart your FEHB in the future.

There are four options to consider when it comes to Medicare and FEHB in retirement: Keep FEHB with Part B, Keep FEHB with no Part B, FEHB Advantage with Part B, or Suspend FEHB and enroll in Part B & Advantage Plan.

Here are the four options in a nutshell:

You can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form if you need to suspend your FEHB enrollment.