FEHB and Medicare

Types of FEHB

The FEHB program offers three enrollment types to accommodate varying family needs:

• Self Only: Coverage for the employee only.
• Self Plus One: Coverage for the employee and one eligible family member.
• Self and Family: Coverage for the employee, their spouse, and children under age 26.

Each health plan within the FEHB program sets its own premiums. The government covers up to 75% of the total cost, while the remaining portion is paid by the enrollee, following a formula established by law.

With over 200 health plan options available, enrollees have a broad range of choices. Fee-for-service plans are open to all eligible participants, though some are restricted to specific employee categories. Additionally, Health Maintenance Organizations (HMOs) are accessible in most regions of the United States.

Enrollment and Open Season

During Open Season, which runs annually from the second full workweek in November to the second full workweek in December, participants can:

• Change health plans.
• Switch enrollment types.
• Newly enroll if eligible.

Outside of Open Season, changes are limited to specific qualifying circumstances.

Additional Benefits

• Flexible Savings Accounts (FSAs): These accounts allow participants to save pre-tax dollars for medical expenses such as out-of-pocket costs, dental and vision care, and even child or adult daycare.
• Federal Dental and Vision Insurance Program (FEDVIP): For those with substantial dental or vision expenses, FEDVIP offers supplemental coverage, making it a smart choice for additional financial protection.

The FEHB program, combined with related benefits like FSAs and FEDVIP, provides comprehensive options to meet the health and financial needs of federal employees and their families.

Medicare

Medicare is the federal health insurance program designed for individuals who are 65 and older, certain younger individuals with disabilities, and those with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, often referred to as ESRD). It is the second-largest social insurance program in the United States, following Social Security.

Medicare is divided into four distinct parts, each covering specific services:

• Part A: Covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care services.
• Part B: Provides coverage for doctor’s services, outpatient care, medical supplies, and preventive services.
• Part C: Often referred to as Medicare Advantage, this is a bundled alternative that combines Part A, Part B, and usually Part D. For federal employees and retirees enrolled in FEHB, Part C is not necessary, as FEHB covers many of the same services.
• Part D: Helps pay for prescription drugs, including many recommended vaccinations and shots.

When you enroll in Medicare, you must choose how you will receive your coverage.

• Original Medicare: This allows you to pay for services as you receive them. With Original Medicare, you’ll pay a deductible at the start of each year and typically 20% of the Medicare-approved service cost, known as coinsurance. For prescription drug coverage, you can add a separate Part D plan. While Part A and Part B cover a significant portion of healthcare services, additional costs like copayments, coinsurance, and deductibles can be addressed with a Medicare Supplement Insurance (Medigap) policy.
• Medicare Advantage: An all-in-one alternative that includes Part A, Part B, and usually Part D. These plans provide extra benefits that Original Medicare does not cover, such as vision, hearing, dental, and more. Medicare Advantage Plans are offered through private insurers with yearly contracts with Medicare, adhering to Medicare’s coverage rules. The plan must notify you of any changes to coverage or costs before the next enrollment period.

Overall, Medicare provides essential health coverage for a variety of needs, with options tailored to individual preferences and circumstances.

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