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Frequently Asked Questions Insurance

  • 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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  • If you are entitled to Part A without paying the premiums, you should take it, even if you are still working. This may help cover some of the costs that your FEHB plan may not cover, such as deductibles, coinsurance, and charges that exceed the plan's allowable charges. There are other advantages to Part A, such as (if you also enroll in Part B,) being eligible to enroll in a Medicare Advantage Plan.
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  • A Self Plus One enrollment covers the enrollee and one designated eligible family member. The definition of eligible family  members has not changed. Your eligible family member can include either a spouse OR a child up to age 26. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member.
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  • If you are an employee, you can cancel or reduce your FEGLI life insurance at any time by submitting this form to your human resources office.

    If you want to reduce life insurance, sign only for the coverage you want to KEEP.  

    If you want to cancel all life insurance, sign in Box 5.

    Exception: if you have assigned your life insurance by transferring ownership to another person or to a company, then you cannot cancel or reduce your Basic, Option A, or Option B coverage.

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  • Outside of Open Season, you can make changes due to certain events, called qualifying life events (QLEs) The most common QLEs for changing enrollment type or plan are: marriage, acquiring a child, moving away from the area served by your Health Maintenance Organization (HMO), losing health insurance coverage, or changing employment status.
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  • The Marketplace will not affect the FEHB Program.   You do not need to take any action regarding your FEHB enrollment or the Marketplace.
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  • To continue your health benefits enrollment into retirement, you must: (1) have retired on an immediate annuity (that is, an annuity which begins to accrue no later than one month after the date of your final separation); and (2) have been continuously enrolled (or covered as a family member) in any FEHB Program plan (not necessarily the same plan) for the five years of service immediately preceding retirement, or if less than five years, for all service since your first opportunity to enroll.
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  • You must contact BENEFEDS in order to change your name and/or address: www.benefeds.com¬†or 1-877-888-3337, TTY 1-977-889-5680.
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  • When you enroll in a Medicare Advantage plan, you may not need FEHB coverage because the Medicare Advantage plan will provide you with many of the same benefits. You should review the Medicare Advantage Plan benefits carefully before making a decision to suspend or cancel FEHB coverage. You should contact your retirement system to discuss suspension and reenrollment.
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  • If you are a retiree, you can cancel or reduce your FEGLI life insurance at any time. There is no form; you must mail a signed letter to OPM's Retirement Office at:

    U.S. Office of Personnel Management
    Retirement Operations Center
    P.O. Box 45
    Boyers, PA 16017-0045

    The cancellation or reduction must be in writing and have an original signature by the insured retiree.  Be sure to include your retirement claim number (CSA) or Social Security Number (SSN) and specify what action you want taken.  Please note that you cannot increase your coverage after retirement or reinstate coverage that you cancel.

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