U.S. Office of Personnel Management

The Federal Employees Health Benefits Program and Medicare



MEDICARE & FEHB PRIMARY PAYER CHART

 When Either You or Your Covered Spouse are Age 65 or over, Have Medicare and FEHB, and You are:  The Primary Payer is:
 An active employee with Federal government (including when you or a family member are eligible for Medicare solely because of a disability)

FEHB

 An annuitant

Medicare

 A reemployed annuitant with Federal government

FEHB, if position not excluded from FEHB
(ask your employing office)

A Federal judge who retired under title 28, U.S.C., or a Tax Court judge who retired under Section 7447 of title 26, U.S.C. (Or your covered spouse is this type of judge)

Medicare

 Enrolled in Part B only, regardless of your employment status

Medicare, for Part B services

 A former Federal employee receiving Workers' Compensation and the Office of Workers' Compensation has determined that you are unable to return to duty

Medicare, except for claims related to the Workers' Compensation injury or illness

 
 When You or a Covered Family Member Have Medicare Based on End Stage Renal Disease (ESRD) and FEHB, and:  The Primary Payer is:
 Are within the first 30 months of eligibility to receive Part A benefits solely because of ESRD

FEHB

 Have completed the 30-month ESRD coordination period and are still eligible for Medicare due to ESRD

Medicare

 Become eligible for Medicare due to ESRD after Medicare became primary for you under another provision

Medicare

 
 When You or a Covered Family Member have FEHB and: The Primary Payer is:
Are eligible for Medicare based on disability

Medicare, if you are an annuitant. FEHB, if you are an active employee

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Page modified 8 June 2001