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Frequently Asked Questions Insurance

I am a reemployed annuitant enrolled in Medicare working in a designated position in the Senate or House of Representatives that is eligible for coverage under plans on the DC SHOP. I transferred my enrollment to the Senate or House of Representatives when I was reemployed and am now enrolled in a DC SHOP plan. If I file a claim, who is first payor – my DC SHOP plan or Medicare?

The FEHB rule regarding reemployed annuitants and whether an OPM-contracted FEHB plan or Medicare pays first is that if the reemployed annuitant is employed in a position that conveys FEHB eligibility, the FEHB plan will be first payor.

Though Members of Congress and designated staff are now enrolled in DC SHOP plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC SHOP plans are still considered to be included under the FEHB umbrella. The same FEHB rules for who is first payor in situations involving an OPM-contracted FEHB plan will apply for DC SHOP plans and the DC SHOP plan will pay first, before Medicare.

It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB eligibility. The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee. The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.

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