FeHB Spouse Coverage After Retirement Guide

As a retiree, you're likely wondering what happens to your FEHB spouse coverage after you retire. Don't worry, you're not alone - many people face this same uncertainty.

FEHB, or the Federal Employees Health Benefits program, offers coverage to spouses of federal employees and retirees. However, the rules for spouse coverage change after retirement.

If you're married to a federal employee or retiree, you're eligible for FEHB coverage as their spouse. But, as a retiree yourself, you may be wondering what your options are for spouse coverage.

The good news is that you can continue your FEHB coverage as a retiree, but the cost and eligibility rules may change.

The Federal Employee Health Benefits Program (FEHB) is a comprehensive health insurance program for federal employees and retirees, and their spouses. It provides essential coverage for medical expenses.

As a retiree, you qualify for FEHB, and it can be a lifesaver with its wide range of benefits.

Optional Medicare coverage can lower your out-of-pocket costs, but you'll have to pay a premium for this extra coverage.

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To be eligible for FEHB program benefits after retirement, your employing office will make a tentative determination, but OPM's Office of Retirement Programs will review the documents and make a final decision.

OPM's Office of Retirement Programs will review the retirement and health benefits documents to determine your eligibility to continue FEHB enrollment into retirement.

The Federal Employee Health Benefits Program provides comprehensive health insurance to federal employees and retirees, and their spouses.

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Service time refers to time in a position where an employee was eligible to be enrolled in the FEHB program, not necessarily time they were enrolled continuously. This includes time covered as a family member under a family member's FEHB program enrollment.

Time covered under the Uniformed Services Health Benefits Program (TRICARE) also counts, as long as the individual was covered under an FEHB enrollment at the time of retirement from federal service.

However, coverage under Medicare does not count in determining continuous coverage.

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At retirement, your employing office will make a tentative determination of your eligibility to continue your FEHB enrollment. This decision will be reviewed and finalized by OPM's Office of Retirement Programs.

Your employing office will review your retirement and health benefits documents to make a final determination. This process ensures that you receive the benefits you're eligible for.

To be eligible for FEHB program benefits after retirement, you must have been continuously enrolled in the program for at least five years. Continuous coverage includes time covered as a family member under a family member's FEHB program enrollment.

Breaks in service won't count against you if you reenroll within 60 days of returning to federal service. This means you can take a break and still meet the five-year requirement.

Jeff's story illustrates this point. He had a break in service from 2020 to 2022 but reenrolled in the FEHB program when he returned to federal service. He was eligible to retire and carry his FEHB program health benefits into retirement because he had been continuously enrolled for five years prior to retirement.

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Enrolling in Part B can be a bit tricky, especially if you already have FEHB coverage. You'll pay a premium for Medicare Part B, which is $174.70/month in 2024 for most people.

Most FEHB plans cover similar expenses to Medicare, but their coverage may be more limited in certain areas, such as orthopedic and prosthetic devices, durable medical equipment, home healthcare, medical supplies, and chiropractic care.

One thing to keep in mind is that FEHB plans cover emergency care received outside the United States, which isn't covered by Original Medicare at all, and is rarely covered by Medicare Advantage. This can be a big advantage if you travel frequently.

If you're enrolled in an FEHB HMO plan, you're normally limited to seeing providers who are part of your plan. Having Part B means you can go outside the HMO's network and see other providers, as long as they accept Medicare.

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You can have both Medicare and FEHB coverage, and they work together to provide healthcare coverage. Medicare is typically available to people 65 or older, or those with specific conditions.

Some FEHB plans waive cost-sharing, like deductibles and co-pays, when you have Medicare Parts A and B. You should contact your FEHB insurer to see if your plan has this feature.

If you're eligible for premium-free Medicare Part A, enrolling in it may help cover deductibles, coinsurance, and other costs beyond those covered by FEHB.

You won't pay less for FEHB premiums if you enroll in Medicare. 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 when you have Medicare Parts A and B.

Contact your FEHB insurer to see if your plan waives cost-sharing for people enrolled in Medicare. This decision can depend on how much you're willing to pay in Part B premiums in exchange for lower cost-sharing when you visit the doctor.

If you earn over $103,000 (or $206,000 for a couple), you'll pay more for Part B in 2024. These higher premiums can range from $244.60/month to $594/month in 2024.

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You generally don't have to sign up for Medicare Part D if you're covered through FEHB, as your prescription coverage may have fewer restrictions.

If you do sign up for Part D, it will usually be your primary insurer, which means you'll have to pay for your prescriptions out of pocket before your FEHB plan kicks in.

Starting in 2024, some FEHB plans shifted to employer group waiver plan (EGWP) Part D coverage, but you were notified and had the option to opt out.

Because FEHB is considered creditable coverage, you won't have to pay a late enrollment penalty if you don't take Part D now and decide to enroll in the future.

If you're eligible for Extra Help, you probably want to use Medicare Part D, as the co-pays are typically lower than the costs in FEHB plans, with some people paying only $4.50 for generics and $11.20 for brand medications in 2024.

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Medicare and FEHB are two separate healthcare programs that work together to provide coverage for federal employees and retirees. You can be eligible for both programs if you're 65 or older, or if you have certain conditions like end-stage renal disease or amyotrophic lateral sclerosis.

The Office of Personnel Management recommends that people with FEHB insurance consider enrolling in Medicare Part A if they're eligible for premium-free coverage, which typically requires 10 years of work and paid Medicare taxes. This can help cover deductibles, coinsurance, and other costs beyond what FEHB allows.

Having Medicare Part A 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. You'll need to contact your FEHB insurer to see if your plan waives cost-sharing for people enrolled in Medicare.

The decision to enroll in Medicare Part B is complicated and depends on whether you have to pay more for it because of your income. If you earn over $103,000 (or $206,000 for a couple), you'll pay higher premiums for Part B in 2024, ranging from $244.60/month to $594/month.

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

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When you're retired and covered by a spouse's FEHB policy, Medicare becomes the second payer, and FEHB pays after that.

If you're retired, with Medicare, and covered by a spouse's policy, the spouse's policy is the primary payer. This means that any medical claims will first go to the spouse's FEHB plan for payment consideration.

Medicare will only become the primary payer if you're not covered by your spouse's policy. In this case, Medicare will pay first, and FEHB will pay after that.

Here are some scenarios where Medicare becomes the primary payer:

In any case, it's essential to understand how premiums and payers work to ensure you're getting the most out of your FEHB and Medicare coverage.