Federal Employee Health Benefits (FEHB) prescription drug coverage is creditable for Medicare-eligible retirees. This means that if you are enrolled in FEHB, you can delay Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. enrollment without incurring a late enrollment penalty (LEP). Be sure to compare the costs and benefits of your FEHB plan and Part D to decide which best suits your needs.
If you are eligible for Extra Help, you may want to consider enrolling in Part D. The drug copayments for individuals who have Part D and Extra Help are typically lower than the copays under FEHB drug coverage. However, your FEHB plan’s formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. may be broader than the formularies of Part D plans offered in your area. You may also want to keep FEHB drug coverage if the plan covers your drugs with no or fewer coverage restrictions Coverage restrictions, also called Utilization Management Tools or formulary restrictions, are restrictions that a health or drug plan may place on certain covered services to limit their usage. Coverage restrictions include prior authorization, quantity limits, and step therapy. than available Part D plans.
If you enroll in both Part D and FEHB drug coverage, Part D is typically the primary payer for your prescription drugs.
Note: FEHB drug coverage cannot be suspended separately from FEHB health coverage. If you want to keep your FEHB health coverage, you must keep drug coverage, even if you enroll in Part D.