Annuitant
As an annuitant, there are some advantages to enrolling in Medicare. It can fill in coverage gaps and along with FEHB is a part of your complete health care package. As an annuitant, there may also be cost savings to enroll in a Medicare plan.
What to consider
Reduced out-of-pocket costs. Some FEHB plans offer reimbursement for Part B premiums. In addition, your FEHB plan may waive its copayments, coinsurance, and deductibles for services covered by Part B.
Broader coverage. Some services covered by Part B might not be covered or are only partially covered by your FEHB plan, such as orthopedic and prosthetic devices, durable medical equipment, home health care, and medical supplies. Check your plan brochure for details.
Expanded provider network. If you are enrolled in an FEHB HMO, you may go outside of the HMO network for Part B services and receive reimbursement by Medicare for services from a provider who accepts Medicare.
Avoid billing errors, by telling your FEHB plan that you have Medicare. As soon as you enroll in Medicare, let your FEHB plan know that you or a covered family member has Medicare coverage.
What happens if you don’t take Part B as soon as you’re eligible
Limited opportunities to enroll. If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the next opportunity to enroll. This means that there may be a gap in time before your Medicare coverage begins.
Must pay late enrollment penalties. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent for each 12 months that you could have had Part B but didn’t take it. You will pay the late enrollment penalty for as long as you have Part B.
How FEHB and Medicare work together
Have your retirement system complete form CMS L564 Request for Employment Information. If you didn’t complete the form CMS L564 as part of your retirement package, your retirement system will need to complete it for you to take advantage of the Special Enrollment Period to enroll in Medicare.
As soon as you enroll in Medicare, tell your FEHB plan if you or a covered family member has Medicare coverage to avoid billing errors.
Premiums. Your premiums for Part B are deducted from your Social Security retirement benefits. If you are not getting Social Security retirement benefits, you can elect to have Part B premiums deducted from your federal annuity. If that isn’t an option, then you will be billed directly. Your FEHB premiums will continue to be deducted from your annuity.
FEHB provides creditable drug coverage. As long as you have FEHB coverage, you will not have to pay a late enrollment penalty if you defer enrolling in Part D.
FEHB is your primary coverage if you receive workers compensation benefits and are determined unable to return to duty. FEHB is your primary coverage and will pay first except for care you receive related to your workers compensation injury.
Examples
Scenarios you may experience or have questions about.
As an annuitant you signed up for Medicare. After a few years, you rejoin the Federal government as a reemployed annuitant and are eligible for FEHB. Your FEHB coverage is your primary coverage during the time you are a reemployed annuitant.
You are retired and have FEHB and Medicare coverage. Your spouse is covered under your FEHB but is not yet eligible for Medicare. Medicare is your primary coverage and FEHB is secondary. Your FEHB continues to be primary for your spouse.
You didn’t enroll in Medicare Part B when you first became eligible since your FEHB coverage met your healthcare needs and paying an additional premium didn’t make financial sense. Over the years your healthcare needs have increased, and Medicare provides coverage that you need. You can enroll in Medicare in the next general enrollment period but will likely have to pay a monthly Part B late enrollment penalty.