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Coverage for Annuitants

  • Original Medicare has four parts:
    Part A (Hospital Insurance) helps pay for:
    • inpatient hospital care
    • critical access hospitals
    • skilled nursing facility care
    • some home health care
    • hospice care
    Part B (Medical Insurance) helps pay for:
    • doctors' services
    • ambulance services
    • outpatient hospital care
    • x-rays and laboratory tests
    • durable medical equipment and supplies
    • home health care (if you don't have Part A)
    • certain preventive care
    • limited ambulance transportation
    • other outpatient services
    • some other medical services Part A doesn't cover, such as physical and occupational therapy
    Part C (Medicare Advantage): If you join a Medicare Advantage Plan you generally get all your Medicare benefits, which may include prescription drugs, through one of the following types of plans:
    • Medicare HMOs – You must get your care from primary care doctors, specialists, or hospitals on the HMO's list of network providers, except in an emergency.
    • Medicare PPO Plans – In most plans your share of plan costs is less when you use in-network primary care doctors, specialists and hospitals. Using out-of-network providers costs you more.
    • Medicare Special Needs Plans – These plans generally limit enrollment to people in certain long-term care facilities (like nursing homes); people eligible for both Medicare and Medicaid; or those with certain chronic or disabling conditions.
    • Medicare Private Fee-for-Service Plans – In these plans, you may go to any Medicare-approved primary care doctor, specialist, or hospital that will accept the terms of the private plan's payment.
    • Medicare Medical Savings Account (MSA) Plans - These plans include a high deductible plan that will not begin to pay benefits until the high annual deductible is met. They also include a medical savings account into which Medicare will deposit money for you to use to pay your health care costs. Medical Savings Account Plans do not cover prescription drugs.
    Part D (Medicare Prescription Drug Coverage) Under this program, private companies provide Medicare Prescription Drug Coverage and you pay a monthly premium. Federal retirees already have excellent access to health benefits coverage for drugs through participation in the FEHB Program. However, if you choose to enroll in Part D, Medicare benefits for drugs will be primary (will pay first) in most cases for FEHB enrollees. (Medicare C plans that include prescription drugs will also be primary to FEHB benefits.) It will almost always be to your advantage to keep your current FEHB coverage without any changes. The exception is for those with limited incomes and resources who may qualify for Medicare's extra help with prescription drug costs. Contact your benefits administrator or your FEHB Program insurer for information about your FEHB coverage before making any changes. It is important to note that FEHB Program prescription drug coverage is an integral part of your total health benefits package. You cannot suspend or cancel FEHB Program prescription drug coverage without losing your FEHB plan coverage in its entirety (in other words, losing coverage) for hospital and medical services which would mean you might have significantly higher costs for those services. Because all FEHB Program plans have as good or better coverage than Medicare, they are considered to offer creditable coverage. So, if you decide not to join a Medicare drug plan now, but change your mind later and you are still enrolled in FEHB, you can do so without paying a late enrollment penalty. As long as you have FEHB Program coverage you may enroll in a Medicare prescription drug plan from November 15 to December 31st of each year at the regular monthly premium rate. However, if you lose your FEHB Program coverage and want to join a Medicare prescription drug program, you must join within 63 days of losing your FEHB coverage or your monthly premium will include a late enrollment penalty. The late enrollment penalty will change each year but will be included in your premium each year for as long as you maintain the coverage.
    Medicare does not cover:
    • your monthly Part B premium or Part C or Part D premiums
    • deductibles, coinsurance or copayments when you get health care services
    • outpatient prescription drugs (with only a few exceptions) unless you enroll in a Part C plan which provides drug coverage or a Part D plan
    • routine or yearly physical exams
    • custodial care (help with bathing, dressing, toileting, and eating) at home or in a nursing home
    • dental care and dentures (with only a few exceptions)
    • routine foot care
    • hearing aids
    • routine eye care
    • health care you get while traveling outside of the United States (except under limited circumstances)
    • cosmetic surgery
    • some vaccinations
    • orthopedic shoes
    Complete Medicare benefits information can be found in the Centers for Medicare and Medicaid Services publication, Medicare & You handbook which can be found on the Medicare website (www.medicare.gov).
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    • OPM's Office of Retirement Programs website. The site provides various categories of information including the questions most frequently asked by annuitants and survivor annuitants.
    • During the year, you may request information such as verification of annuity or the value of life insurance as well as make changes to your own retirement account, such as federal and state income tax withholding changes, by calling OPM on the toll-free number 1-888-767-6738, TDD for the hearing impaired 1-800-878-5707, or send email to retire@opm.gov. The automated telephone system is available 24 hours a day, 7 days a week.
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  • During the annual Open Season, OPM sends Open Season material to all those enrolled in the FEHBP plus those who have suspended their enrollments to enroll in a Medicare-sponsored plan approved by the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA) and to enroll in TRICARE.
    • OPM provides Open Season Express, an operator supported toll-free telephone service for retirees to call to request brochures, health benefits satisfaction surveys, and make enrollment changes using telephone technology. The phone number is 1 (800) 332-9798.
    • OPM also provides an interactive Open Season website at retireefehb.opm.gov/.
    • There are other events that allow retirees or their survivors to make enrollment changes -- such as a move out of the service area of an HMO, enrollment in Medicare, or a change in marital status. These events are given in the FEHB Handbook. During the year, annuitants should call OPM on the toll-free number 1-888-767-6738, TDD for the hearing impaired 1-800-878-5707, or send email to retire@opm.gov. Annuitants in the Washington DC local calling area should dial (202) 606-0500, or (202) 606-0551 for the hearing impaired.
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  • Annuitant Open Season changes are effective January 1.
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  • To inquire about how much coverage you have under the Federal Employees Health Benefits (FEHB) Program, go to Retirement Services Online at https://www.servicesonline.opm.gov.  You will need your retirement claim number and Personal Identification Number (PIN) to access information about your health benefits enrollment.    If you cannot access Retirement Services Online, you can inquire about your coverage by contacting OPM’s Retirement Office at 1-888-767-6738 or retire@opm.gov.  The phone lines are open from 7:30 am to 7:45 pm (Eastern Standard Time). It is a busy phone number so we encourage you to call early in the morning or after 5:00 pm when the phone lines are less busy.
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  • First, call your plan. If they tell you they haven't gotten the paperwork yet from your retirement system, you may contact your retirement system. If you are a Civil Service Retirement System (CSRS) annuitant or a Federal Employees Retirement System (FERS) annuitant, contact OPM at 1-888-767-6738. Before contacting your retirement system, have your annuity information ready: your name, civil service annuity number (beginning with CSA or CSF), phone number and address, and information about your plan, such as the carrier enrollment code.
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  • Be careful. Such a cancellation would be permanent. Annuitants cannot re-enroll in the program except under very limited circumstances, such as to enroll in a Medicare-sponsored health plan, as described below, or TRICARE. Another exception is if your spouse is also a Federal employee and you cancel to be covered by your spouse's FEHB plan. Further, neither you nor your family members would be eligible for continued coverage nor would you be able to convert your coverage to a private non-group policy. Do not drop out of the program unless you are sure of being able to re-enroll.
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  • You may contact OPM's Retirement Office by phone at 1 (888) 767-6738 or by e-mail at retire@opm.gov. The phone lines are open Monday through Friday 7:30am to 7:45pm eastern time.  If you have difficulty getting through, try to call early in the morning or late in the evening when the lines are less busy.
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  • No.  FEHB law does not permit any exclusions or waiting periods for pre-existing conditions in any plan in the FEHB Program.  This is also true if you change plans after you retire. 
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  • The effective date for the new FEHB Self Plus One enrollment type will be January 1, 2016. Therefore, the annual Open Season beginning on November 9, 2015 will include the new Self Plus One enrollment type in the enrollment choices available.
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  • Yes, retirees/annuitants are eligible to participate in a FEDVIP dental plan, a FEDVIP vision plan, or both. Retirees must have retired with an immediate annuity (a FERS Minimum Retirement Age plus 10 annuity, postponed, counts as an immediate annuity). Those in receipt of a deferred annuity are not eligible to enroll in FEDVIP. Retirees can cover their eligible family members with a Self Plus One or Self and Family enrollment. More information is available on types of enrollments and eligible family members
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  • An eligible individual may choose one of the following enrollment options:
    1. Self Only, which covers only the enrolled employee or annuitant; or
    2. Self and Family, which covers the enrolled employee or annuitant and all eligible family members
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  • Section 706 of the Bipartisan Budget Act of 2013 which amends Section 8905 of title 5, United States Code, to add a Self Plus One enrollment type to the FEHB Program.
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