U.S. Office of Personnel Management

The Federal Employees Health Benefits Program and Medicare

Must I Use My FEHB HMO's Participating Providers When Medicare is Primary?

If you want your FEHB HMO to cover your Medicare deductibles, coinsurance, and other services it covers that are not covered by Medicare, you must use your HMO's participating provider network to receive services and get the required referrals for specialty care.

If I Go to My FEHB HMO's Providers, Do I Have to File a Claim With Medicare?

No. If needed, your HMO will file for you and then pay its portion after Medicare has paid.

Do I Have to Pay Medicare's Deductibles and Coinsurance When I Use My FEHB HMO's Doctors?

No. Your HMO will pay the portion not paid by Medicare for covered services.

Do I Have to Pay My FEHB HMO's Copays?

Usually, you will still have to pay your FEHB HMO's required copays. Some HMOs waive payment of their copays and deductibles when Medicare is primary. Check your FEHB plan's brochure for details.

Table of Contents