Fehb Open Season Retirees: Navigating Health Benefits After Retirement

As a retiree, navigating your health benefits can be a daunting task, especially during the FEHB Open Season. You can enroll in, change, or cancel your FEHB plan during this period, which typically runs from November to December.

The FEHB Open Season is a great opportunity to review and adjust your health insurance coverage to meet your changing needs. You can choose from a variety of plans offered by different carriers, each with its own set of benefits and costs.

If you're new to the FEHB program, you'll need to enroll in a plan within 60 days of your retirement eligibility date. This is a one-time process, and you'll be automatically enrolled in a plan if you don't take any action.

Don't worry if you're unsure about which plan to choose - the FEHB Open Season is a great time to explore your options and find a plan that suits your needs and budget.

If you're a federal retiree, you're likely familiar with the FEHB program. This program offers a range of health insurance options to choose from.

One important fact to keep in mind is that you need to be enrolled in the FEHB plan on the day you retire from federal service to be eligible to use it later.

The five-year rule is another important consideration. If you're under the TRICARE program, it can actually help you meet this rule, but you still need to be enrolled in the FEHB plan on the day you retire.

You're not typically in both TRICARE and FEHB at the same time. If you're moving outside of a highly military-populated area, you might find it harder to access providers under TRICARE, so you could switch back to FEHB if it's a better option.

The key is to be enrolled in the FEHB plan on the day you retire, and TRICARE can help you meet the five-year rule, but not the "day of" rule.

To be eligible for FEHB coverage as a retiree, you must meet two key requirements. You must retire on an immediate pension under FERS or CSRS, and you must have been continuously enrolled in an FEHB plan for at least 5 years immediately before your retirement date.

There are a few ways your FEHB coverage can count towards the 5-year rule. Your own FEHB coverage, being covered as a family member, and even being covered under TRICARE if you were covered under an FEHB plan at the time of your retirement all qualify.

If you've made changes to your FEHB coverage at Open Season, don't worry – it won't affect your eligibility. As long as you've been covered in FEHB for the 5 years immediately before your retirement date, you'll be good to go.

Here are the two requirements you must meet to retain FEHB access for yourself as an employee:

It's worth noting that there are no waivers for these requirements. Make sure you meet both to keep your FEHB coverage.

FEHB premiums are set to increase by about 13.5% on average for 2025, almost double the increase from last year.

This is a significantly larger increase than in recent years, with the average enrollee increase being only 3.8% just three years ago.

The rising cost of FEHB coverage includes not only premiums but also out-of-pocket expenses like copays, deductibles, and co-insurance.

As FEHB coverage becomes more expensive, it can be harder to pay the premium, especially if other sources of income aren't keeping up with inflation.

Make sure to consider all the costs, not just the premiums, and how you'll absorb them if you meet your out-of-pocket maximum.

While working, you have the perk of premium conversion, which allows you to pay FEHB premiums with pre-tax money, avoiding federal and state taxes.

However, in retirement, you no longer have premium conversion, so you'll have to pay premiums with after-tax money, taking a larger initial pot of money and paying taxes on it.

As an FEHB member, you have access to a vast network of providers for care wherever you are in the U.S, as well as access to more than 65,000 pharmacies nationwide. This is especially important for retirees who may need to travel or move to a different area.

UPMC doctors, for example, have a strong reputation, with nearly 400 of their physicians recognized as 2024 "Top Doctors" across more than 60 specialties. These doctors are part of the Castle Connolly Top Doctor list, which is entirely merit-based and cannot be paid for.

To retain FEHB access for yourself as an employee, you'll need to meet two key requirements: you must have been enrolled in the program for five years immediately preceding your retirement, and you must be enrolled on the day you retire.

As an FEHB member, you have access to a vast network of healthcare providers. This includes nearly 400 UPMC physicians who were recognized as 2024 "Top Doctors" across more than 60 different specialties.

These physicians represent more than half of the doctors listed in Pittsburgh. They were part of the Castle Connolly Top Doctor selection process, which is entirely merit-based and doesn't allow doctors to pay to be listed.

You can receive care from these providers wherever you are in the U.S. Additionally, you have access to more than 65,000 pharmacies nationwide for your convenience.

To keep FEHB access, you must meet two requirements. You've got to have been enrolled in the program for five years immediately preceding your retirement from federal service.

The first requirement is to have been enrolled in FEHB for five years prior to retirement. The second requirement is to be enrolled in FEHB on the day of retirement.

There are no waivers, so it's essential to meet both requirements. You can switch plans within the FEHB program during this five-year period.

Here are the two FEHB requirements:

Dental and Vision, however, does not have a five-year rule, so you can keep it even in retirement.

Your family members can retain access to FEHB coverage after you die, but there's a key difference: they don't have a five-year rule like you do as an employee.

To keep FEHB, family members must be covered under your plan before you die. This means they need to be enrolled in your plan at the time of your passing.

Family members can be added or removed during open seasons or if you experience a qualifying life event, such as getting married, divorced, or having a child.

Retirement, however, is not considered a qualifying life event, so you can't adjust your FEHB coverage just because you're retiring.

To keep FEHB for your spouse, they must be named as a minimum survivor annuitant and receive a portion of your pension every month.

A disabled child can also retain access to FEHB, but they must be deemed disabled prior to age 18 and incapable of self-support, and your agency must certify this fact.

The TRICARE program is a game-changer for military recipients, offering a platinum standard of healthcare. It's no wonder that veterans make up a significant portion of the federal workforce, and many have questions about how it works.

One of the key benefits of TRICARE is that it can help you meet the five-year rule required for FEHB coverage. If you're retired from the military and have been under TRICARE, you can use that time to satisfy the five-year rule, which is a huge perk.

But here's the catch: you still need to be enrolled in the FEHB plan on the day you retire from federal service to be eligible for it later. TRICARE can help you meet one rule, but not the other.

If you're in a highly military-populated area, TRICARE is likely to serve you well. However, if you move outside of one of those areas, you might have a harder time accessing the providers you need under TRICARE.

Almost half of all FEHB carriers offer plan options that provide additional benefits and incentives for those under Medicare Part B.

These plans can reimburse Part B premiums or waive out-of-pocket medical expenses outside of prescription drugs.

About 70% of federal retirees enroll in Part B, which means paying two premiums and essentially two duplicative insurance programs.

39 plans will offer Medicare Advantage or Medicare Part D plans that automatically coordinate with FEHB coverage.

FEHB coordination is a significant change for next year that you should be aware of. Almost half of all carriers offer plan options that provide additional benefits and incentives for those under Medicare Part B.

About 70% of federal retirees enroll in Part B, which means paying two premiums and essentially two duplicative insurance programs. It's worth it for retirees who join Part B and get access to FEHB Medicare Advantage plans that can reimburse Part B premiums or waive out-of-pocket medical expenses outside of prescription drugs.

39 plans will offer Medicare Advantage or Medicare Part D plans that automatically coordinate with FEHB coverage. Most prescription drug plans will also auto-enroll you if you have Medicare Parts A and B or just Part A.

You can find Medicare information in Section 9 of each FEHB plan brochure. Specific coverage can be found in Sections 5(b) and 5(f) of plan brochures.

To continue your FEDVIP coverage at retirement, you must retire on an immediate pension under FERS or CSRS and pay premiums during the period of finalization of your pension by OPM.

You'll receive bills from BENEFEDS during this period and must pay the bills promptly. After OPM finalizes your pension, premiums are automatically deducted from your pension each month.

There is no 5-year continuous enrollment requirement for FEDVIP, so you can elect coverage or cancel coverage during the annual Open Season.

To make the most of your FERS health insurance benefits, make sure to factor in the monthly costs of FEHB and/or Vision and Dental Coverage in your retirement planning and preparation.

If you're married, you'll want to have a conversation about survivor benefit options and FEHB in retirement.