FEHB & Medicare
You have three options and only one of them is irreversible. Keeping your FEHB plan, suspending it and cancelling it are three different forms with three different consequences, and the difference between the second and the third is the rest of your life.
No plan described here is a veterans plan, a VA plan, a military plan or a federal employee plan. Medicare Advantage and Part D plans are private insurance. None is issued by, sponsored by, endorsed by or affiliated with the Department of Veterans Affairs, the Department of Defense, any branch of the armed services, or the Office of Personnel Management. Your VA, TRICARE, CHAMPVA, FEHB or PSHB coverage is administered by those agencies and nothing on this page changes it.
Suspending and cancelling are not the same form
OPM permits an annuitant to suspend FEHB coverage in order to enrol in a Medicare Advantage plan, and to return during a later Open Season — or immediately, if the Medicare Advantage plan is involuntarily lost. Cancellation is generally permanent. An annuitant who cancels rather than suspends usually cannot get FEHB back, ever, and loses the government's share of the premium along with it. Suspension is a specific written request through your retirement office on Form RI 79-9. Before you sign anything, call OPM Retirement Services at 1-888-767-6738 and get the answer for your own enrolment. This is not a decision to take from an insurance agent, including us.
FEHB & Medicare, step by step
First, make sure what you have is actually an FEHB plan
A federal retiree's Blue Cross, GEHA, Aetna or Kaiser plan is an FEHB plan — not a Medicare Advantage plan — even though those same carrier names also appear on Medicare Advantage plans sold to the general public. Several of those carriers now also offer Medicare Advantage options inside the FEHB programme, which compounds the confusion. Look at the card before anybody tells you what you have.
Confirm with: OPM Retirement Services — 1-888-767-6738
How FEHB and Medicare pay together
For annuitants enrolled in Medicare Part A and Part B, Medicare typically pays first and FEHB pays second. Many FEHB plans waive or reduce deductibles and copays when Medicare is primary, and some offer a Part B premium reimbursement or credit — which is plan-specific and worth reading your own brochure for. Federal employees enrolled in FEHB for the five years immediately before retiring, who retire on an immediate annuity, generally carry FEHB into retirement for life with the government continuing to pay its share.
Confirm with: OPM Retirement Services — 1-888-767-6738
Option one: keep FEHB and add a Medicare Advantage plan with no Part D
Most people do not know this is allowed. OPM states that an individual may enrol in a Medicare Advantage plan and also remain enrolled in an FEHB plan. You keep your federal coverage and its creditable drug benefit; the Medicare Advantage plan pays first and the federal plan coordinates as secondary, the same role it played under Original Medicare. Because the FEHB drug benefit stays in force, the structure that fits is a plan with no Part D in it. One step gets missed: OPM requires you to tell your FEHB plan that you have enrolled in a Medicare Advantage plan, because the plan needs to know which one you have in order to coordinate correctly. Make that call.
Confirm with: OPM Retirement Services — 1-888-767-6738
Option two: suspend FEHB and take a plan that includes Part D
Suspension is reversible and it removes the FEHB premium — though OPM does not contribute anything toward a Medicare Advantage premium, so the saving is not the whole difference. Suspension also ends the federal plan's drug benefit, which means a suspending enrollee needs Part D coverage from somewhere. Suspension is a closed list, not a general right: OPM permits it only to move onto specific coverages — Medicare Advantage, Medicare cost plans or health care prepayment plans, or Medicaid or a similar state-sponsored programme, or TRICARE, TRICARE For Life, CHAMPVA or Peace Corps. Medigap is not on that list and neither is a standalone Part D plan. OPM states that a copy of the Medicare card alone will not allow an enrollee to suspend.
Confirm with: OPM Retirement Services — 1-888-767-6738
If anyone else is on your enrolment, suspension suspends them too
FEHB suspension applies to the enrolment, not merely to the annuitant. When an annuitant suspends a Self and Family enrolment, coverage is suspended for every family member covered under it — including a spouse. A spouse who is under 65, or otherwise not Medicare-eligible, can be left with nothing. If anyone else is covered under your enrolment, do not file a suspension request until replacement coverage has been worked out for every person on it.
Confirm with: OPM Retirement Services — 1-888-767-6738
Option three: cancel — see the box above
Cancellation is the one that does not come back. If you are being encouraged to cancel FEHB in order to take a Medicare plan, stop, and call your retirement office before you sign. No insurance agent should be taking that application on the same day the subject comes up, and we will not.
Confirm with: OPM Retirement Services — 1-888-767-6738
Where Part D fits, and how FEHB differs from PSHB here
FEHB prescription drug coverage is creditable, so you are not accruing a penalty. FEHB annuitants with Medicare are now generally auto-enrolled into their plan's Medicare Part D arrangement, with a window to opt out. The difference that matters: an FEHB member who leaves that arrangement generally falls back on the plan's standard drug coverage. A PSHB member who leaves theirs is left with no plan drug coverage at all. If you are postal, read the PSHB page rather than this one — and either way, check your own plan brochure, because this varies by carrier.
Confirm with: OPM Retirement Services — 1-888-767-6738
Where the drug coverage question lands
Every kind of coverage on this page already includes prescription drug coverage that Medicare counts as creditable — meaning it is at least as good as a Part D plan, so you are not building a late-enrollment penalty while you hold it. That one fact decides the shape of any Medicare Advantage plan that would make sense next to it.
A Medicare Advantage plan that carries no Part D drug coverage is usually written as “MA-Only” or a medical-only plan. It covers what Part A and Part B cover, plus whatever extras the plan includes, and it leaves your existing drug coverage alone. For two of the programmes below, that is not a preference — adding Part D takes a benefit away.
Check this yourself
Nothing here is a decision about your benefit. These are the people who administer it and can tell you how it applies to you.
- OPM Retirement Services — 1-888-767-6738 · www.opm.gov
- Medicare — 1-800-MEDICARE · www.medicare.gov
Talk it through with somebody who knows how these fit together
No medical questions, no pressure, and no application on the first call. If the honest answer is that your existing coverage already does the job, that is the answer you will get.
The ones that come up every week
Does enrolling in a Medicare Advantage plan affect my VA health care?
No. Your VA enrolment, your Priority Group and your disability compensation are administered by VA and are not changed by a private insurance enrolment. What a Medicare Advantage plan does is give you a way to get care outside the VA system. It pays nothing toward care you receive at a VA facility.
I use the VA for all my prescriptions. Do I need a Medicare drug plan?
Generally no. VA pharmacy benefits are creditable prescription drug coverage, which means you are not building a Part D late-enrolment penalty while you use them. The same is true of TRICARE, CHAMPVA and federal plan drug benefits. Confirm your own situation with the programme that administers your coverage.
Can I keep my FEHB plan and take a Medicare Advantage plan at the same time?
OPM states that an individual may enrol in a Medicare Advantage plan and also remain enrolled in an FEHB plan. If you do, OPM requires you to tell your FEHB plan, because it needs to know whether you have Original Medicare or a Medicare Advantage plan in order to coordinate benefits correctly. Confirm the specifics with your own carrier and with OPM at 1-888-767-6738.
What is the difference between suspending and cancelling FEHB or PSHB?
Suspension is reversible — an annuitant can return during a later Open Season, or immediately if a Medicare Advantage plan is involuntarily lost. Cancellation is generally permanent, and takes the government's share of the premium with it. They are different administrative actions. Before filing either, call OPM Retirement Services at 1-888-767-6738 and get the answer for your own enrolment.
I get my CHAMPVA medications in the mail. Should I take a Medicare drug plan?
VA states that Meds by Mail is available only to CHAMPVA beneficiaries with no other prescription coverage, and that you do not need Part D to get CHAMPVA. A Medicare drug plan would end Meds by Mail rather than add to it. Confirm with CHAMPVA at 1-800-733-8387 before changing anything.
Will a Medicare Advantage plan lower my Part B premium?
Some plans include a Part B premium reduction, often called a giveback. It is a feature of particular plans in particular counties rather than something Medicare Advantage does generally, and the amount varies. It is worth asking about for your own county, and worth checking on Medicare.gov rather than taking anyone's word for it — including ours.
Does TRICARE For Life end if I join a Medicare Advantage plan?
No. You still have Medicare, the Medicare Advantage plan becomes the primary payer, and TRICARE For Life remains the second payer for TRICARE-covered services. Note that TRICARE's guidance says Medicare Advantage claims do not cross over automatically, so a claim may occasionally need following up. Dropping Part B, on the other hand, does end TRICARE For Life.