Federal retiree HMOs (through the Federal Employees Health Benefit Program or FEHBP) provide coverage to all their subscribers, even if they don’t have Medicare. You do not need Medicare Part B as you would if you were in a fee-for-service plan. Since your HMO copayments may be small (such as $10 per doctor visit), it may not be worth paying the monthly Medicare Part B premium for Medicare to pay your out-of-pocket costs.

However, if at any point you want to switch to a fee-for-service plan (for example, if your doctor leaves the HMO’s network), you would need Medicare Part B. If you wait to enroll in Part B until the need arises, you may have to pay a premium penalty for late enrollment. Some other things to consider:

  • If you travel extensively in the United States, Part B coverage could be used to help pay for non-emergency medical services while traveling out side of the HMO’s service area.
  • You could use Part B coverage to go out of network to see a specialist in cases where the HMO primary care physician will not provide a referral.
  • A number of FEHBP plans have left the program in the past several years. You may want to take Part B when you first become eligible so that you do not have to pay a Part B premium penalty in the event that your plan stops providing FEHBP coverage.

For more information, contact the National Association of Retired Federal Employees (NARFE) at 800-627-3394.