Not affiliated with The United States Office of Personnel Management or any government agency

Not affiliated with The United States Office of Personnel Management or any government agency

Benefits of the FEHB Program and the Role of Medicare

Health programs have many procedures that are covered to provide help in every way. People have many concerns when they look for the federal health benefits program. To every question, there is an answer. A whole list of options is covered in this program. Here are some of them.

What types of programs are being offered by Medicare?

Medicare beneficiaries can enroll in Original Medicare or choose an option in which they will benefit from medical advantages. It depends on where you live and the covered plans under your preferred choice. You can almost ask for every medical expense. Medicare will help you pay for insurance like critical access hospitals, skilled nursing facilities, and home health care. Other than that, they allow you to pay for medical insurance, including services of doctors, ambulances, X-rays and tests, preventive maintenance, OPD and medical equipment. Moreover, you are eligible for these services if you are above the age of 60 years. Also, if you have many serious problems like disabled or chronic kidney disease, including End-stage Renal Failure, you might need to contact the Social Security Administration.

If I have FEHB coverage, will I need Medicare coverage too?

If you have coverage for hospital expenses and have not paid premiums, you can have it even if you are an employee. It might cover some of the costs that the FEHB plan does not cover. Also, if you already have the coverage, you would not need to have a Medigap policy. FEHB and Medicare will coordinate and provide the benefits you need. They offer a wide range of medical expenses, covering almost everything that needs to be done. 

If I work past age 65, will my FEHB coverage remain primary?

Yes, your FEHB coverage will remain primary. It will remain the same until you retire. Moreover, if you are concerned about the payments, you can continue paying the same premiums until you switch your plan to another. If you plan to switch your plan to Medicare and they become the primary, it would be dealt with accordingly. Once Medicare becomes the primary payer, you will have to not worry about FEHB since they are lower in cost. It would be sufficient for your needs. It will be better, especially if you are enrolled in an expensive plan.

If I go to my FEHB HMO’s providers, do I have to file my claim with Medicare?

No. If there is a need, your HMO will file for you, and then they will pay the portion after Medicare has paid. Usually, you will pay the FEHB HMO copays required for the procedure. However, some HMOs let go of payment of their copays. Also, you should always check your plan’s brochure for more details and clarifications. Alternatively, your HMO will pay for the portion not covered by Medicare services.

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