Federal Employee Health Benefits

Medicare Frequently Asked Questions

Do I have to take Part B coverage?

You don't have to take Part B coverage if you don't want it, and your FEHB plan can't require you to take it. There are some advantages to enrolling in Part B:
•You must be enrolled in Parts A and B to join a Medicare Advantage plan.
•You have the advantage of coordination of benefits (described later) between Medicare and your FEHB plan, reducing your out-of-pocket costs.
•Your FEHB plan may waive its copayments, coinsurance, and deductibles for Part B services.
•Some services covered under Part B might not be covered or only partially covered by your plan, such as orthopedic and prosthetic devices, durable medical equipment, home health care, and medical supplies (check your plan brochure for details).
•You may go outside of the plan's network for Part B services and receive reimbursement by Medicare (only when Medicare is the primary payer) If you are enrolled in an FEHB HMO.

What happens if I don't take Part B as soon as I'm eligible?

If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up10 percent for each 12 months that you could have had Part B but didn't take it. You will pay the extra 10 percent for as long as you have Part B. If you didn't take Part B at age 65 because you were covered under FEHB as an active employee (or you were covered under your spouse's group health insurance plan and he/she was an active employee), you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working or are no longer covered by the group plan. You also can sign up at any time while you are covered by the group plan.

Q. How much does Part B coverage cost?
Q. Does the FEHB program offer Medigap Policies?
Q. Do I need a Medigap Policy when I have FEHB and Medicare coverage?
Q. Does my FEHB Plan or Medicare pay benefits first?
Q. When is my Medicare Plan the primary payor?
Q. When is my FEHB Plan the primary payor?
Q. If I have FEHB, Medicare and other coverage, which coverage is primary?
Q. If I work past Age 65, is FEHB still my primary coverage?
Q. Do my FEHB Premiums change when Medicare becomes primary?
Q. Will my FEHB fee-for-service plan cover all of my out-of-pocket costs not covered by Medicare?
Q. Must I use my FEHB HMO's participating providers when Medicare is primary?
Q. If I go to my FEHB HMO's providers, do I have to file a claim with Medicare?
Q. Do I have to pay Medicare's deductible and co-insurance when I use my FEHB HMO's doctors?
Q. Do I have to pay my FEHB HMO's co-pays?