More Medicare questions? What federal retirees should know

Have questions about HSA contributions, TRICARE For Life, or whether you can keep FEHB or PSHB after enrolling in Medicare? The answers below can help clarify the details of federal health benefits.

As noted in this column recently, the biggest and often most confusing Medicare question for federal retirees is whether they must sign up at age 65. The Postal Service Health Benefits (PSHB) Program, put in place in 2025, simplified that decision for most Postal Service annuitants by requiring Medicare Parts A and B in order to keep PSHB coverage.

Some Postal Service annuitants and family members do not have to enroll in Medicare Part B to remain covered under a PSHB plan:

• Postal Service annuitants who retired on or before Jan. 1, 2025, and who are not already enrolled in Medicare Part B.

  Their family members also are not required to enroll in Medicare Part B to be covered by a PSHB plan.

• Postal Service employees who are age 64 or older on Jan. 1, 2025.

  These employees do not have to enroll in Medicare Part B after retiring in order to enroll in PSHB as annuitants. Their family members also are not required to enroll in Part B after the employee retires to remain covered under a PSHB plan.

Retirees often ask many other Medicare questions. Here are some of the most common.

Is it better to enroll in Medicare Part A while you are still working, or not?

The choice is up to you, but in most situations it makes sense to enroll in Part A during your initial enrollment period, a seven-month window that begins three months before the month of your 65th birthday. Having Part A can lower your out-of-pocket costs and reduce expenses for FEHB, which may help keep FEHB premiums lower.

Part A covers certain institutional and end-of-life services, especially hospice care and up to 100 days in a skilled nursing facility under strict conditions that FEHB and PSHB plans often restrict, limit, or exclude. It also helps pay for a range of home health services for an illness or injury, whether the goal is recovery, maintenance, or slowing decline. Home care is often less expensive and more convenient than hospital or skilled nursing facility care.

One drawback is that enrolling in Medicare Part A means you can no longer contribute to a Health Savings Account (HSA). The IRS says you must meet all of these conditions to contribute to an HSA:

• You are covered by a high-deductible health plan (HDHP) on the first day of the month.

• You do not have other health coverage except what IRS rules allow.

• You are not enrolled in Medicare.

• You cannot be claimed as a dependent on someone else’s tax return.

Timing also matters. If you enroll in Medicare after age 65, premium-free Part A can apply retroactively for up to six months, but not before the month you turned 65. To avoid possible tax penalties, stop HSA contributions at least six months before enrolling in Medicare.

Does it ever make sense to enroll in Medicare Part B if I still have FEHB or PSHB coverage and I am still working for the government?

At age 65, most people in the United States should enroll in Original Medicare Parts A and B. However, because Part B requires a monthly premium, some people choose Part A only and delay Part B because they:

• Are still working and covered by an employer group health plan.

• Have a spouse who is working and covered under that spouse’s employer-sponsored group health plan.

If you are covered through your own current employment or your spouse’s current employment, you may delay Part B without a late enrollment penalty. You can sign up during the Special Enrollment Period, which usually lasts eight months after your employment ends or your group coverage based on current employment ends, whichever comes first. Because that clock can start before you officially retire, it is important to know when your coverage ends and enroll on time.

Exception for TRICARE: TRICARE For Life (TFL) is available to eligible beneficiaries who have Medicare Parts A and B. Enrollment in TFL happens automatically once you meet the eligibility rules and have both parts of Medicare.

“TRICARE For Life is Medicare-wraparound coverage. This means Medicare and TRICARE work together to coordinate your benefits and reduce your out-of-pocket medical costs,” said Anne E. Breslin, TRICARE For Life program manager. “You’ll pay nothing out of pocket when the services you receive are a benefit of both Medicare and TRICARE.”

If you qualify for TFL, you generally must have both Medicare Parts A and B to keep that coverage. Even though federal employees may be able to delay Part B while covered by an employer group health plan, they should not assume they can postpone Part B and keep TFL in the meantime. Check with TRICARE before making a decision about enrollment.

It is also important to keep your information current in the Defense Enrollment Eligibility Reporting System (DEERS) for you and your family. DEERS is the database for uniformed service members, their families, and others eligible for military benefits, including TRICARE. Keeping your information updated is your responsibility and helps ensure access to benefits without delay. Review your information whenever you have a life-changing event. For more details, see the TFL handbook.

I’m a TFL beneficiary and a retired federal employee. Can I suspend my Federal Employees Health Benefits Program coverage to use TFL?

Yes. If you are retired, you may suspend FEHB coverage and premium payments at any time. Go to opm.gov/forms to obtain a Health Benefits Cancellation/Suspension Confirmation form (RI 79-9). Make sure to fill out the “Suspension” section.

If you later decide to restore FEHB, you can re-enroll during FEHB Open Season. If you cancel FEHB, you cannot get it back. Eligible former spouses who have not remarried can obtain the form from the employing office or retirement system that manages their enrollment.

What is the difference between FEHB and Medicare Part C and FEHB with Medicare Parts A and B? You pay Part B premiums either way.

Medicare Part C is also known as Medicare Advantage. It is an alternative arrangement in which Medicare Parts A and B pay first, with your FEHB or PSHB plan acting as the secondary payer.

To enroll in Part C, you must first be enrolled in Medicare Parts A and B. You still pay your Part B premium when you are in any Medicare Advantage plan.

Medicare Advantage plans cover Medicare-approved Part A and Part B services and may also include extra benefits that vary by plan. Some plans include features such as a $0 deductible. When offered through your FEHB or PSHB carrier, your Part B premium may be reduced by a monthly amount that can reach $75 to $125 or more in some plans.

You may also gain access to programs that support your health goals, such as gym memberships, allowances for over-the-counter medical products, dental and/or vision coverage, and more. These extras depend on the plan.

Because many FEHB and PSHB plans offer a Medicare Advantage option, you may still use your doctors or other providers if they are:

• Eligible to receive payment under Medicare.

• Willing to bill and accept payment from the FEHB or PSHB plan.

These plans can cost less than Original Medicare because of Part B premium reductions, lower premiums and out-of-pocket costs for some FEHB or PSHB plans, and added benefits. Some FEHB and PSHB carrier plans also include foreign travel coverage. Since benefits vary, review the details carefully before enrolling.

Possible downsides include a greater need for referrals and prior approval for certain services and prescriptions. There is also a chance your provider may not bill or accept Medicare or your plan. That risk may be lower when Medicare Advantage coverage is offered through a group employer-sponsored plan such as FEHB or PSHB, since many of these plans provide nationwide coverage.

A group Advantage plan administers Medicare Parts A and B benefits for retired employees. Medicare pays the insurance company a fixed monthly amount, and the company must make sure its Advantage plans follow Medicare rules.

Who needs to be notified if I am enrolled in Medicare Parts A and B and FEHB or PSHB?

Call the number on the back of your FEHB or PSHB card to let the plan know you have enrolled in Medicare and are either still working or retired.

Pharmacies: If you enroll in or switch to a new Medicare Part D prescription drug plan, let your local pharmacy know so it can update your billing profile.

Providers: Tell your doctor and other health care providers about any insurance or coverage changes when you receive care. It may also be necessary to remind providers if you did not enroll in Medicare and are age 65 or older, since they may assume Medicare should be billed first.

If you have questions about who pays first or whether your coverage has changed, call the Medicare Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627).

To enroll in Medicare Part A and/or Part B, sign up through Social Security.

To enroll in a Medicare Advantage option through your FEHB or PSHB carrier, call the dedicated Medicare Advantage line for your plan. You should be notified when you change plans, or you can check the Medicare Advantage page on your FEHB or PSHB plan website.

After signing up for Medicare, what happens to family members who are not eligible for Medicare? Can they be covered under my FEHB or PSHB insurance as their primary insurance?

Your spouse and eligible children, including those under age 26 or disabled children who cannot support themselves, remain fully covered under your Self Plus One or Self and Family FEHB or PSHB enrollment.

If you are still an active employee and have FEHB or PSHB as an employee, your plan remains the primary payer for you and your family members even if you enroll in Medicare.

If you retire and keep FEHB or PSHB through your CSRS or FERS annuity, the rules depend on who is covered. For you and/or your spouse covered under your health plan, Medicare becomes primary once you enroll, and FEHB or PSHB becomes secondary. For your spouse or children who are not covered by Medicare, such as a younger spouse, your FEHB or PSHB plan remains their primary coverage.

I have presented several webinars on Medicare and FEHB. If you would like to view those sessions, they are recorded and archived, and upcoming programs can be found at https://www.benefeds.gov/learn/info/webinars and https://www.narfe.org/education/narfe-webinars/.