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Frequently Asked Questions
QUESTIONS ABOUT COVERAGE FOR ANNUITANTS

What do Civil Service Retirement System (CSRS) and Federal Employees Retirement System retirees have to do to change health insurance?

  • About 1.8 million annuitants and survivor annuitants are enrolled in the FEHBP. 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 HMO.
  • OPM provides Open Season Express, a toll-free telephone service for retirees to call to request brochures, health benefits satisfaction surveys, and make enrollment changes using telephone technology.
  • This Open Season OPM will provide an interactive Open Season Website at http://www.opm.gov/retire/fehb.
  • There are other events which 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. 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 e-mail to retire@opm.gov.

When will my open season change to the new coverage be effective?

Annuitant open season changes are effective January 1.

I am an annuitant. I changed my health insurance in open season and haven't gotten an identification card even though it is late January; what can I do?

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. Before contacting your retirement system, have your annuity information ready, for instance, 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.

I am retired and will be moving to another state in the next few months. I am currently in a health maintenance organization (HMO). Will I be covered after I move?

You will be covered for emergency care. Unless your HMO has a "reciprocity" agreement with a plan in your new area that allows you to get routine care, you must travel back to your HMO for care, or change plans. You can change plans anytime after moving; contact your retirement system.

I am retired but my spouse is not. I want to drop out of the Federal Employees Health Benefits Program for a year or two because my spouse has good free coverage from her employer for the both of us. Will there be any penalty?

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 HMO, as described below. 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.

I am a retired Federal employee with Federal Employees Health Benefits Program coverage and soon I will be eligible to enroll in Medicare too. If I choose to enroll in Medicare, should I drop my enrollment under the Federal Employees Health Benefits Program or should I continue with both?

When you become eligible for Medicare (generally at age 65), you can continue to maintain your Federal Employees Health Benefits Program coverage. In most cases, Medicare is primary and your Federal Employees Health Benefits Program plan will be secondary. You may want to shop for a lower level of coverage.

Many health maintenance organizations (HMOs) contract with the Health Care Financing Administration (HCFA) to provide benefits to Medicare beneficiaries. You may - but are not required to - suspend your Federal Employees Health Benefits Program coverage to join a Medicare HMO but there are restrictions, as described below. You must be enrolled in Medicare Parts A and B to be eligible to enroll in a Medicare HMO.

When a plan in the Federal Employees Health Benefits Program has a Medicare HMO too, there is a page in the plan's brochure titled "Non-Federal Employees Health Benefits Program Benefits Available to Plan Members." Plans use that page to advertise their Medicare HMO.

If you are a Federal annuitant and you think you might be interested in a Medicare HMO, please keep two things in mind. First, when you enroll in a Medicare HMO, your Federal Employees Health Benefits Program coverage is not automatically suspended. You need to contact your retirement system for information on what you need to do to suspend your Federal Employees Health Benefits Program enrollment for a Medicare HMO. And, second, understand that family members may not be eligible for coverage under the Medicare HMO, and that the Medicare HMO's benefits may not be identical to the benefits your plan covers under the Federal Employees Health Benefits Program. Also, if you are enrolled in a particular Federal Employees Health Benefits Program plan because of particular health needs, make sure the Medicare HMO you choose also will meet those needs.

If I continue my Federal Employees Health Benefits Program coverage as a retiree, do I have to enroll in Medicare Part A or Part B, or both?

To continue your Federal Employees Health Benefits Program coverage, you will not be required or expected to enroll in Medicare, although most annuitants do enroll.

Most annuitants aged 65 and over are eligible for Medicare benefits under either Part A, Part B, or both. You probably will not have to pay a premium for Medicare Part A, especially if you retired since 1983. (All Federal employees became subject to the Medicare withholding tax in 1983 and, hence, are covered for benefits under Part A upon reaching the minimum age for Medicare qualification.) You must pay a premium for Part B. Many retirees find it worthwhile to enroll in Part B as soon as they become eligible (usually age 65) because the Part B premium is higher if you enroll at a later date.

Where can Civil Service Retirement System (CSRS) and Federal Employees Retirement System (FERS) annuitants get answers to other questions about retirement benefits?

  • OPM's Office of Retirement Programs Website at http://www.opm.gov/retire. 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 e-mail to retire@opm.gov. The automated telephone system is available 24 hours a day, 7 days a week.

Modified 1 November 1999