The Original Medicare Plan (Medicare Part A & B) is available everywhere in the
United States. It is the way everyone used to get Medicare benefits and is the
way most people get their Medicare Part A and Part B benefits now. You may go to
any doctor, specialist, or hospital that accepts Medicare. The Original Medicare
Plan pays its share and your supplemental FEHB coverage often pays the
difference and if you carry both Part A and B most FEHB plans waive the
deductible, copayments and coinsurance. Some things are not covered under
Original Medicare, like prescription drugs.
Medicare Health Benefits Plan Menu
If you fall under one of the following criteria you are eligible to sign up
- People 65 years of age and older.
- Some people with disabilities under 65 years of age.
- People with End-Stage Renal Disease (permanent kidney failure requiring
dialysis or a transplant).
- Part A (Hospital Insurance). Most people do not have to pay for Part A.
If you or your spouse worked for at least 10 years in Medicare-covered
employment, you should be able to qualify for premium-free Part A insurance.
(Someone who was a Federal employee on January 1, 1983 or since
automatically qualifies.) Otherwise, if you are age 65 or older, you may be
able to buy it. Contact 1-800-MEDICARE for more information.
Federal employees are eligible to receive part A coverage without a premium
because we paid Medicare tax on our earnings while employed. Essentially, if
you or your spouse worked for 10 years or more in Medicare-covered
employment, you are eligible for free Part A hospital insurance. Applying
for Part A is a cost effective option for most because with the majority of
FEHB plans your hospital copayments and coinsurance are waived. They don't
waive prescription copayments or coinsurance. It's important to know that
when Medicare A coverage limits are reached most plans require the patient
to pay any difference between the FEHB provider allowance and the billed
amount or pay the inpatient hospital per-day copayments depending on the
plan you are enrolled in.
If you decide not to apply for Medicare at age 65 the 2014 Blue Shield plan
brochure states, "Under the FEHB law, we must limit our payments for
inpatient hospital care and physician care to those payments you would be
entitled to if you had Medicare. Your physician and hospital must follow
Medicare rules and cannot bill you for more than they could bill you if you
had Medicare. You and the FEHB benefit from these payment limits. Outpatient
hospital and non-physician based care are not covered by this law; regular
Plan benefits apply." Essentially your doctors aren't going to receive more
than the Medicare payment schedule whether or not you elect Medicare
When you sign up for Medicare and are retired, your FEHB insurance becomes
your supplemental coverage and Medicare is your primary health care provider
and they pay first. Your FEHB plan picks up the difference to the extent
outlined in your plan's benefit brochure, review Section 9 thoroughly. If
you only pick up Part A your FEHB plan will remain your primary coverage for
your medical Insurance including doctor's visits while Medicare A will be
primary for your hospital coverage. If your spouse is under age 65 their
primary provider will be your FEHB plan until they reach age 65.
For more in-depth information on Medicare A read Medicare and FEHB Options -
What Will You Do When You Turn 65? (Part 1).
- Part B (Medical Insurance). Most people pay monthly for Part B.
Generally, Part B premiums are withheld from your monthly Social Security
check or your retirement check.
Medicare B (Medical Insurance) that covers physician and outpatient care
requires more thought because all must pay an income adjusted monthly
premium for coverage. If you don't take Part B at first eligibility (at 65
if retired and not covered under a working spouse or new employer plan; or
within 8 months of post 65 retirement or loss of coverage under a working
spouse after 65) there is a 10% penalty on the current year premium added
for each year you delay enrollment.
If you are 65 or over and still employed by the federal government or are a
65 year old retiree that has health care coverage through your new employer
or you are covered under a working spouse exemption, you can delay applying
for Part B without penalty and that makes sense for many. You can delay
taking Part B without penalty if you switch FEHB coverage to a federally
employed spouse to keep the benefit premiums non-taxable and delay without
penalty for the 65 year old retiree's Part B enrollment. Unfortunately
retiree's FEHB premiums are considered taxable income unlike active federal
Many retirees work at another job or start businesses after they leave
federal service. Federal retirees can also delay taking Part B without
penalty if they are covered under a working spouse exemption or while
working for other employers that provide primary healthcare coverage where
the FEHB becomes secondary. You have to evaluate the costs to see if
accepting insurance from your new employer would reduce your costs. If you
start your own business or work for another company that doesn't provide
primary health insurance you will be assessed a penalty if you don't take
Medicare B at age 65.
Medicare Part B premiums are determined by your Modified
Adjusted Gross Income (MAGI). The more you earn the higher your
Part B premium. For most beneficiaries, the government pays a
substantial portion—about 75 percent—of the Part B premium, and the
beneficiary pays the remaining 25 percent. If you’re a higher-income
beneficiary, you’ll pay a larger percentage of the total cost of Part B
based on the income you report to the Internal Revenue Service (IRS).
You’ll pay monthly Part B premiums equal to 35, 50, 65, or 80 percent of
the total cost, depending on what you report to the IRS. Generally, your
Modified Adjusted Gross Income (MAGI) is the total of your household's
Adjusted Gross Income plus any tax-exempt interest income you may have
(these are the amounts on lines 37 and 8b of IRS from 1040). Review
Rules for specifics.
For more in-depth information on Medicare B including information and
Tricare for Life read What to Consider Before Enrolling in Medicare
B (Part 2) Also read the article titled
Should You Change to a
Lower Cost FEHB Plan When You Sign Up For Medicare (Part 3) due out
- Part C (Medicare Advantage). If you are eligible for Medicare, you may
have choices in how you get your health care. Medicare Advantage is the term
used to describe the various health plan choices available to Medicare
beneficiaries. If you are eligible for Medicare, you may choose to enroll in
and get your Medicare benefits from a Medicare managed care plan. These are
health care choices (like HMOs) in some areas of the country. In most
Medicare managed care plans, you can only go to doctors, specialists, or
hospitals that are part of the plan. Medicare managed care plans provide all
the benefits that Original Medicare covers. Some cover extras, like
You can enroll in a Medicare Advantage plan to get your Medicare benefits.
Medicare Advantage is the term used to describe the various private health
plan choices available to Medicare beneficiaries.
If you sign up for Medicare Advantage Part C FEHB coverage isn't necessary.
if you are considering a Medicare Advantage Plan, Part C, instead of the
Original Plan, DON'T drop your FEHB, instead suspend with
proof of signing up for the Medicare Advantage Plan so you can get your FEHB
back the next open season if the coverage doesn't work out. Annuitants can
call OPM's Retirement Information Office at 1-888-767-6738 to obtain a
suspension form. Callers within the local Washington, DC calling area must
call 202-606-0500. Section 9 of your FEHB plan covers the different Medicare
options and what costs they will waive and pay when you sign up. Your
health plan may also offer a booklet on this subject that will help you
understand the impact.
To learn more about enrolling in a Medicare Advantage
plan, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or at
- Part D (Medicare prescription drug coverage). There is a monthly premium
for Part D coverage. Most Federal employees do not need to enroll in the
Medicare drug program, since all Federal Employees Health Benefits Program
plans will have prescription drug benefits that are at least equal to the
standard Medicare prescription drug coverage. Still, you may want to be
aware of the benefits Medicare is offering, so you can help others make
informed decisions. If you have limited savings and a low income, you may be
eligible for Medicare's Low-Income Benefits. For people with limited income
and resources, extra help in paying for a Medicare prescription drug plan is
available. Information regarding this program is available through the
Social Security Administration (SSA). For more information about this extra
help, visit SSA online at
www.ssa.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
The FEHB health plan brochures explain how they coordinate benefits with
Medicare, depending on the type of Medicare managed care plan you have. If you
are eligible for Medicare coverage read this information carefully, as it will
have a real bearing on your benefits.
The decision to enroll in Medicare is yours. OPM encourage you to apply for
Medicare benefits 3 months before you turn age 65. It's easy. If you do not apply for one or more Parts of
Medicare, you can still be covered under the FEHB Program. Visit their website
for forms and additional information.
If you can get premium-free Part A coverage, OPM advises you to
enroll in it. Most Federal employees and annuitants are entitled to
Medicare Part A at age 65 without cost. When you don't have to pay premiums for
Medicare Part A, it makes good sense to obtain coverage. It can reduce your
out-of-pocket expenses as well as costs to FEHB, which can help keep FEHB
Everyone is charged a premium for Medicare Part B coverage. The Social
Security Administration can provide you with premium and benefit information.
Review the information and decide if it makes sense for you to buy the Medicare
Part B coverage. For additional information on Medicare B here is list of
articles that will help you decide:
If you are eligible for Medicare, you may have choices in how you get your
health care. Medicare Advantage is the term used to describe the various private
health plan choices available to Medicare beneficiaries. The information in the
next few pages shows how we coordinate benefits with Medicare, depending on
whether you are in the Original Medicare Plan or a private Medicare Advantage
premiums for Medicare Part A (Hospital Insurance) are free if you or
your spouse paid Medicare taxes while working. This is referred to as
"premium-free Part A." If you must buy Part A, it will cost you up to $411
Most people get Part A without having to pay a premium. Premiums for Part
A are free at 65 if:
- You already get retirement benefits from Social Security or the
Railroad Retirement Board.
- You're eligible to get Social Security or Railroad benefits but
haven't filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you're under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability
benefits for 24 months.
- You have
End-Stage Renal Disease (ESRD) and meet certain requirements.
In most cases, if you opt to purchase Part A, you must also take Medicare
Part B and pay a monthly premium for both.
If your yearly income
in 2014 (for what you pay in 2016) was
You pay (in 2016)
File individual tax
File joint tax return
File married & separate
$85,000 or less
$170,000 or less
$85,000 or less
above $85,000 up to $107,000
above $170,000 up to $214,000
above $107,000 up to $160,000
above $214,000 up to $320,000
above $160,000 up to $214,000
above $320,000 up to $428,000
above $85,000 and up to $129,000
Your Medicare claim number is your Social Security number followed by one
of the suffixes listed below. The suffix identifies your benefit status.
- A – Primary Claimant (wage earner)
- B – Spouse (spouse of retired worker)
- B1 – Aged Husband, age 62 or over
- B2 – Young Wife, with a child in her care
- B3 – Aged Wife, age 62 or over, second claimant
- B5 – Young Wife, with a child in her care, second claimant
- B6 – Divorced Wife, age 62 or over
- BY – Young Husband, with a child in his care
- C1-C9 – Child (includes minor, student, or disabled child)
- D – Aged Widow age 60 or over
- D1 – Aged Widower, age 60 or over
- D2 – Aged Widow (2nd claimant)
- D3 – Aged Widower (2nd claimant)
- D6 – Surviving Divorced Wife, age 60 or over
- E – Widowed Mother
- E1 – Surviving Divorced Mother
- E4 – Widowed Father
- E5 – Surviving Divorced Father
- F1 – Parent (father)
- F2 – Parent (mother)
- F3 – Stepfather
- F4 – Stepmother
- F5 – Adopting Father
- F6 – Adopting Mother
- HA – Disabled Claimant (wage earner)
- HB – Aged Wife of Disabled Claimant, age 62 or over
- HC – Child of Disabled Claimant
- M – Uninsured – Premium Health Insurance Benefits (Part A)
- M1 – Uninsured – Qualified For (but refused health insurance
benefits – Part A)
- T – Enrolled in Medicare but temporarily delayed Social Security
Retirement Benefits or Uninsured – Entitled to Health Insurance
Benefits (Part A) under deemed or renal provisions
- TA – Medicare Qualified Government Employment (MQGE)
- TB MQGE – Aged Spouse
- W – Disabled Widow
- W1 – Disabled Widower
- W6 – Disabled Surviving Divorced Wife
- WA – Railroad Retirement
If you are retired military or a military spouse and
have TriCare you must sign up for Medicare Part B in the 3 months before
turning 65 in order to continue with
TriCare for life. TriCare participants are able to
suspend their FEHB enrollment if they wish after retiring from federal
service; federal employees can't
suspend FEHB coverage while still working.
The time you had with TriCare counts towards the 5
years of FEHB coverage that participants must have to carry FEHB coverage
into retirement and you must be enrolled in a FEHB plan at retirement to be
able to suspend it. If you choose to stay with TriCare and suspend FEHB
participation as a civilian retiree, you can sign back up for FEHB during
any subsequent open season should you need private insurance coverage. This
would be desirable if health care providers are not taking new
Medicare/TriCare patients when you move to a new location or otherwise lose
your doctor. "
If you are retired and receiving Social Security you will automatically
be enrolled in Part A and B and should receive your Medicare card three
months before your 65th birthday. If you decide not to take Part B follow
the instructions that you receive with your enrollment package. If you
Security you have a 7 month Medicare enrollment window that starts 3
months before your birthday. You can sign up online at
http://www.socialsecurity.gov/medicare/apply.html or you can visit your local
Social Security Office to apply. Call 1-800-772-1213 for additional
information and assistance. You can also sign up for Medicare at
http://www.medicare.gov under the "New
to Medicare" section. It takes about 15 minutes to register and sign up
If you are retired but covered under a working spouse’s medical plan or
you are still working, sign up for Part A and then advise them that you do
not want part B because you are covered by your employer or under a working
spouse plan as the case may be. All current federal employees and those
retirees with new employer health care coverage or are covered under their
spouse should elect this when they turn 65 to delay Part B without penalty
until their working spouse retires, or they leave federal service, or their
You can withdraw from Medicare Part B at any time if desired. Once you
withdraw from Medicare B you would have to notify your FEHB provider, Blue
Cross Blue Shield in your case, immediately because they would revert back
to primary provider for medical services. To cancel Medicare Part B coverage
you will have to use form CMS-1763. This form isn’t available online and you
must contact your Social Security Administration office to complete the
form. They will discuss the consequences of canceling your coverage,
including how penalties are accessed, and process the form for you over the
phone. The Social Security FAQ titled
How do I terminate my enrollment with Medicare Part B when I have other
health insurance explains the process in more detail. Typically your
monthly premium for Part B may go up 10% for each full 12-month period that
you could have had Part B, but didn’t sign up for it.
If you are eligible for Medicare and not eligible for Social Security, you can have Medicare
premiums withheld from your annuity payments. OPM must receive a request for the
withholding from the Centers for Medicare and
Medicaid Services. They cannot withhold premiums based on your direct
request or even one from the Social Security Administration. The request must
come from the Centers for Medicare and Medicaid Services (CMS) to
Medicare premiums from annuity payments.
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