Federal Employee Health Benefit (FEHB) plans cover current and retired government employees. They are administered by the Office of Personnel Management (OPM).
FEHB plans can be either Health Maintenance Organizations (HMOs) or Fee-for-service (FFS) plans. HMOs have networks of providers, and you must usually see in-network providers to be sure services are covered. In an HMO, your out-of-pocket costs may be lower than in other plan types. FFS plans allow you to see any medical provider, but you may have higher costs.
FEHB plans follow some of the same coordination of benefits rules and rules for delaying Medicare enrollment as non-federal job-based insurance and retiree insurance— with a few important exceptions. Because you or your spouse work for the federal government—an employer with 100+ employees—FEHB is always primary during active employment. Additionally, if you meet other requirements, you will have a Special Enrollment Period (SEP) to enroll in Part B when you are no longer covered by FEHB insurance based on current work.
If you are entitled to FEHB retiree insurance based on your or your spouse’s previous job, you do not have an SEP. When you become Medicare-eligible, you can:
- Decide to keep FEHB and enroll in Medicare Parts A and B.
- Disenroll from your FEHB coverage and enroll in Medicare.
- Turn down Medicare Part B and keep FEHB.
Unlike other retiree insurance, FEHB will pay primary if you do not enroll in Part B. Therefore, in any of these cases, you will have primary coverage. However, you should consider each option and your health insurance needs before deciding whether or not to delay Medicare enrollment.