By Reg Jones
Q. Can a retired employee quit his Federal Employees Health Benefits in retirement for, say, Tricare for Life and Medicare if retired military, and later opt to switch back to FEHB?
Q. My husband worked for a Veterans Affairs medical center for seven years, then left federal employment for eight years. He is 63 and receiving a deferred annuity. He may be returning to federal employment. When he returns, is there a certain amount of time he must be re-employed to be able to retire and carry his health benefits into retirement?
A. If your husband was re-employed, he’d be able to enroll in the FEHB program during the next open season. He would then have to be enrolled for five years to continue that coverage when he once again retired.
Q. I would appreciate a clarification of eligibility for Federal Employees Health Benefits under postponed retirement. I selected a postponed retirement and have recently begun receiving benefits. I may, at some point, want to sign up for FEHB as a FERS retiree. In my situation, in my last government position (as an appointee), I had continuous coverage under my wife’s FEHB as a part of a family plan. Since I left the government position, I have continued to be covered under my wife’s FEHB family plan. As I understand it, postponed retirees who were enrolled at the time they left government can re-enroll once they start benefits. In my case: Am I eligible for benefits even though I was not enrolled myself but was covered under my wife’s plan? Given that I am still covered under my wife’s plan, can I, if it makes sense, enroll myself in an FEHB plan?
A. Yes, but only if your wife switches to self-only at the same time during an open season or if she passes on before you while you are still covered by her self and family enrollment.
Q. I am a FERS employee. I will be drawing my reservist retirement June 27 at 60 years old. Can I drop my Federal Employees Health Benefits for Tricare? Can you give me details about this how long will it take, if this has to be done at open season and the grace period on the policy?
A. You can get an FEHB suspension form by calling the Office of Personnel Management’s Retirement Information Office at 1-888-767-6738. They may be able to tell you how long it takes.
Q. My December federal retirement take-home pay was $1,609.11. My January federal retirement take-home pay was $1.645.66. My February federal retirement take-home pay was $1,511.67. My take-home pay was reduced by $133.99. In my 15 years of retirement pay, I have never seen this much taken for medical at once. For the past few years, my take-home pay has continued to reduce. Inflation is not keeping up with medical costs. What’s going on?
A. All plans in the Federal Employees Health Benefits program are experience-rated. This means that the premiums in the current year are based on an analysis of the premiums the plan took in versus the expenditures it made to pay enrollee claims. While sometimes a plan’s premiums go down, they often go up. To find out if the change you experienced is the result of increased plan premiums, go to www.opm.gov/healthcare-insurance/healthcare/plan-information/premiums and check the rates for 2012 and 2013.
The only way you can moderate the effects of premium increases is to shop around among the many plans in the FEHB program and find one that meets your needs but has lower rates. One of the benefits of the FEHB program is that you can change plans during any open season.
Q. I have worked for the Veterans Affairs Department as a civilian for more than five years. My wife always handled the health care insurance under her company’s program, so I never took advantage of mine. We are now in our 18th month of divorce and I would like to go on my health care program under my benefits at VA. My human resources department says I need a divorce decree to be able to get coverage. My wife is about to lose her job, so I am worried that I may be without coverage. What should I do?
A. If your wife loses her coverage as a result of losing her job, you might be able to enroll in the Federal Employees Health Benefits program under Code 1M of the Office of Personnel Management’s Table of Permissible Changes in Enrollment. Check with your personnel office. If you don’t, you’d have to wait until the next open season to enroll.
Q. My husband and I are both military retirees and have had Tricare for over 38 years. When my husband turned 65, he had to sign up for Medicare and take Part B to retain Tricare for Life. He also dropped off of the Federal Employees Health Benefits plan and then retired from his civilian federal government job and I changed to single coverage on FEHB under me (I am still working as a civilian federal employee).
I am considering retiring this year and want to know if I need to add him to my FEHB for him to have access to FEHB in the future if we need that. Do I need to put him on my FEHB next open season to retain this benefit in the future?
A. To retain FEHB coverage, he would need to be covered under your FEHB enrollment when you died. Since you can’t predict when that will happen, it would be wise to change your coverage from self-only to self and family while you are still healthy.
Q. I am about ready to retire and currently maintain a FEHB policy. My wife is still working and I can fall under her health plan at no extra cost, and the coverage is better. I have been told that you can “suspend” FEHB in retirement and reinstate it if need be. Is this true?
A. No, it isn’t true. About the only ones who can suspend coverage are those who are covered by the military’s Tricare program. And they can only re-enroll if they lose that coverage or during an open season.
Q. I am a FERS retiree with premium deductions from my annuity for Federal Employees Health Benefits family coverage. My wife is not a federal retiree.
1. If I change to single during open season, can I change back to family coverage the next year?
2. When I die, I assume FEHB coverage will halt for her, correct?
A. Yes, you can change from self-and-family coverage to self-only during any open season and change back during any open season. If you provided a survivor annuity for your wife, and you are covered by the self-and-family option when you die, she will be able to continue that coverage; if you were enrolled in self-only, she wouldn’t.
Q. I am a retired foreign service officer whose spouse is still an active federal employee working for an agency other than the State Department. To save money, we decided to move from one self-and-family policy under my name to separate self-only plans. I opted for a completely different carrier, while my wife chose to stay with the one we had had for six years.
We had not counted, however, on the fact that this year, there would be a nearly two-week gap between the time frame for changes for retirees and for active employees. The end result has been that my self-and-family coverage ended Dec. 31, but my wife’s self-only coverage will only begin with the start of a new pay period Jan. 13. I confirmed with my former carrier that, despite having a record of her new enrollment, there was nothing it could do to continue her coverage without some sort of code or certification from my wife’s agency or the Office of Personnel Management. State essentially confirmed this and added that it would only have been able to modify my wife’s action had she also worked for State. My wife’s agency, meanwhile, seems to have been caught flat-footed by this problem and, after initially pronouncing her out of luck, claims to be researching her situation and that of a few others similarly affected.
This sort of Catch-22 is quite frustrating, not to mention upsetting. Neither my wife nor I saw any information during the open season warning of this potential pitfall much less guidance on how to avoid it. I advised State human resources, when I filed my change, that my wife would drop from my coverage to obtain her own through her agency. She, however, did not do so since her agency’s online enrollment procedure did not seem to allow for that.
Can you please advise as to how this should have been handled and what sort of remedial action (OPM code, certification) is possible? My wife is in good health and could probably make it to the 13th without problem, but her lack of coverage during an emergency is worrying. She has also already had to postpone seeking an elective appointment and been declined insurance coverage for a prescription she rushed to have filled on the 31st. It is hard to believe that the Federal Employees Health Benefits plan regulations would not address such a gap, greater this year than in most, given the number of mixed marriages between active and retired feds.
A. What happened is unfortunate. However, I’m not aware of any action you could take that would change that.
Q. I am 65 and signed up for Medicare Parts A and B. I also continued my BCBS standard option health coverage after reading the FEBH/Medicare brochure.
I believe it is recommended that I continue the BCBS coverage. I received an email regarding the open season and am very confused as to whether I should continue the BCBS standard option or switch to a Medicare Supplement plan. Looking at the open season email and some of the links, I think I need to consider some Medicare Supplements. I think I would have to suspend my health benefits if I were to enroll in a Medicare Supplement plan. I am just not certain that would be best thing to do. Any guidance would be greatly appreciated.
A. No, you don’t need to purchase a Medigap policy, since FEHB and Medicare will coordinate benefits to provide comprehensive coverage for a wide range of medical expenses. Further, because you are a retiree, if you dropped your FEHB coverage, you wouldn’t be able to re-enroll.
Q. I am a CSRS employee with 34 years of federal service. I am going to retire in 2013. If I suspend my Federal Employees Health Benefits to go under my husband’s Tricare, will I still be able to reinstate my FEHB any time I want during an open season after I become an annuitant? Also, will I still be able to join the long-term federal health insurance plan?
A. Yes to both questions. If you suspend your coverage to be under Tricare, you can re-enroll in the FEHB program during any open season. You can enroll in the Federal Long-Term Care Insurance Program as an employee or a retiree.
Q. I know one has to have Federal Employees Health Benefits for five years before one quits or retires to get this benefit. Does it have to be family coverage for five years, or can I change my self-only coverage to family in the last year before retirement? Can I change it after retirement?
A. You can change from self-only to self and family and from self and family to self-only during any open season. The only requirement to carry your FEHB coverage into retirement is that you be covered continuously for the five years before you retire.
Note: I need to correct a misunderstanding on your part. If you were to quit, you would only be able to continue your coverage for 18 months under the temporary continuation of coverage provision, for which you’d pay 100 percent of the premiums, plus a 2 percent administrative fee.
Q. I plan to continue my federal health care plan after I retire next year. Will I still have the option to switch providers in the future during open season? Do I have to enroll/sign up for Medicare Part A? Is there any general guidance on whether I should pick up Medicare Part B on top of my existing Federal Employees Health Benefits HMO?
A. Yes, you can change your FEHB provider during any open season. While you don’t have to sign up for Medicare Part A, there’s no reason not to do so. You’ve already paid for it through payroll deductions. As for Part B, it’s your choice based on your needs and expectations. The Office of Personnel Management has a website that may help you make up your mind. Go to www.opm.gov/insure/health.medicare/index.asp.
Q. I’m 64½ years old, retired FERS with Federal Employees Health Benefits. No dependents. I am also retired military, but I have never used Tricare. I am now considering what to do in this open season and as I reach 65 years of age.
This is my plan:
1) Enroll in a cheaper (I have Kaiser now), more reasonably priced FEHB during open season.
2) Suspend that new FEHB coverage using form RI 79-9 to OPM.
3) Use my Tricare Standard until I reach 65 years (five months from now).
4) Find a Physician who take Tricare Standard.
5) Enroll in Medicare Part A and Part B.
Did I miss anything? Should I suspend FEHB now or only when I reach 65 years? Can you give me your thoughts on my additional dental and vision insurance through FEHB? I have only used the dental insurance and never the vision insurance. When I turn 65, will I need these with Medicare and Tricare?
A. You’ll find your answer at www.opm.gov/insure/health/faq/tricare.asp.
Just scroll down to “How can an annuitant or former spouse suspend FEHB coverage to use CHAMPVA or TRICARE.”
December 10th, 2012 | Uncategorized
Q. My husband and I are postal employees. He is getting ready to retire after 32 years with the Postal Service, and he is 59. I am 51 and will be continuing my employment probably (God willing) for another eight years or so. We both carry self-only health insurance plans, and I was wondering if I can take him on my insurance plan before he retires and change my enrollment to self and family. If this is a possibility, he can drop his plan. I think this would save us money, as I think his insurance will go up in his retirement. First, is this an option for us? How would I change my plan to self and family?
A. You could change from self only to self and family coverage during the FEHB open season.
November 30th, 2012 | Uncategorized
Q. If I change my health insurance to self-only (due to my wife having insurance through her company) and I retire next year, can I add her back to mine if she loses or changes jobs. I ask because it’s open season and I plan on retiring the end of May from the Postal Service. I have my minimum retirement age and 31 years, three of which are my military buyback.
A. As a retiree, you could change from self-only to self and family under Qualifying Life Event 2G. And you could do that from 31 days before through 60 days after her loss of coverage.
November 29th, 2012 | Uncategorized
Q. I am a federal employee with 32+ years of civil service, planning on retiring in the next five years. I have been enrolled in a Federal Employees Health Benefits plan throughout my career. My husband retired from active duty Aug. 31 with 23+ years. We had dual coverage under Tricare and FEHB since August 1995, with FEHB being primary and Tricare as secondary. Now that my husband has retired, to continue to be covered under Tricare, he had to sign up for a specific Tricare plan, for which we are now charged a monthly premium. We are trying to determine whether or not we should cancel the FEHB and save the $3,500 per year. The Tricare representatives advised my husband that we should suspend the FEHB and not cancel it, so if we decided at a later date to re-enroll in the FEHB, we could. I have also read that if I don’t have FEHB for five years prior to retiring, I won’t be able to sign up for FEHB coverage when I retire, but that I can include the time in Tricare toward that five years.
I went to the BENEFEDS and Office of Personnel Management websites and contacted a benefits and entitlements counselor through the Employee Benefits Information System to ask this question, but I am receiving conflicting information.
1. Can I suspend my FEHB and re-enroll, as long as it is during open season, at any time?
2. Can I cancel my FEHB and re-enroll, as long as it is during open season, at any time?
3. So if I cancel/suspend my FEHB and retire in five years, can I count the time in Tricare toward being enrolled in a FEHB plan?
4. If I cancel/suspend my FEHB and am no longer covered under Tricare (through no fault of my own) I can re-enroll in FEHB plan at any time; I don’t have to wait for an open season?
5. Can I sign up for a dental plan and/or a vision plan under the FEHB without being enrolled in a FEHB plan?
A. You can suspend your coverage in the FEHB in favor of Tricare. If you do, you could reactivate that coverage at any time if you were to lose Tricare coverage sometime in the future. If you canceled your FEHB coverage and were still employed, you could re-enroll at a later date; however, you would be required to maintain that FEHB coverage for five consecutive years to be able to carry it into retirement. If you canceled that coverage and retired, you wouldn’t be able to re-enroll. Retirees cannot re-enroll in the FEHB program. Finally, dental and vision coverage isn’t tied to enrollment in FEHB.
November 26th, 2012 | Uncategorized
Q. My husband is a retired FERS employee and I am a current CSRS employee. I am covered as a family member under my husband’s self-and-family coverage. My husband did not elect a survivor annuity. I plan to retire the end of this year. What happens to my Federal Employees Health Benefits coverage if he dies before me? Will I be able to continue the coverage based on my own eligibility, even though he did not elect a survivor annuity? If I elect self-only coverage during the next open season, the change is not effective until Jan. 13, while any changes to my husband’s coverage would be effective Jan. 1.
A. If your husband were to die before you, you could continue that coverage. If you were still employed, the premiums would be deducted from your pay; if retired, from your annuity. There wouldn’t be any break in coverage, and you could, if he died, switch to self-only at that time.
August 31st, 2012 | Uncategorized
Q. I am currently retired (CSRS) and have single coverage under the Federal Employees Health Benefits plan. My spouse is still employed by the federal government (FERS) and has single coverage under FEHB. We were both under my family plan until our youngest child became ineligible. We then went to self-only plans because the premiums were less together than the family plan. She will be eligible for retirement in three years. She is also considering simply quitting before then and taking a deferred retirement when she is eligible.
I am not covering her for spousal annuity, nor will she be covering me. We plan to put her on a family plan with me when she retires. If she retires (or quits) before she has established five consecutive years as self-only under FEHB, will she eligible to gain self-only under FEHB in case of my death? If not, can she continue self-only into retirement (or deferred) and then join me later under the family plan?
A. She doesn’t have to have been enrolled in a self-only option for five years to take that coverage into retirement; she only needs to have been covered by or enrolled in the FEHB program for that long. If she were to leave the government before being eligible to retire, she would receive a 30-day extension of her coverage at no cost to herself and, if she chose, enroll in her current plan or another for up to 18 months under the temporary-continuation-of-coverage provision. If she did so, she’d be required to pay 100 percent of the premiums plus 2 percent for administrative costs. Alternatively, and a much more sensible choice, during a health benefits open season before she resigns from the government, you could switch to a self-and-family option of your plan. During the next open season after she began receiving her deferred annuity, the two of you could switch back to self-only options.