FEHB and Medicare enrollment changes


Q. My wife became entitled to Medicare FEHB Part A effective Feb. 1, 2011, and Part B effective Sept. 1, 2011, then recently, she enrolled in a Medicare Advantage Plan, specifically the 2012 United Health Care Chronic Complete (HMO SNP) Plan. During open season, I changed my enrollment from self and family to self only effective Jan. 1, 2012. I become eligible for Medicare effective June 13, 2012, when I turn 65. I understand that I may suspend my FEHB enrollment once I join a Medicare Advantage Plan. I also believe that if I am an enrolled annuitant, I may subsequently change plans, options, or type of enrollment (self only or self and family) during open season, however, if I am a nonenrolled annuitant, I am not permitted to re-enroll during an open season unless I had canceled my FEHB enrollment to join a Medicare Advantage Plan and I have subsequently voluntarily disenrolled from a Medicare Advantage Plan. If I suspend my enrollment in FEHB, am I then considered to be a nonenrolled annuitant?  If I enroll in a Medicare Advantage Plan in 2012 and I suspend my FEHB self-only enrollment, must I have self and family coverage in effect under FEHB in order to provide coverage for my wife. In addition, does she have to be eligible for coverage under the Medicare Advantage Plan in which I choose to enroll? Based upon the information I provided above, is it possible, if I suspend my FEHB enrollment and later re-enroll during open season, to cover my wife under self and family?

A. According to OPM, “As an annuitant you can suspend your Federal Employees Health Benefits (FEHB) enrollment to enroll in a Medicare Advantage plan, Tricare, CHAMP VA, Medicaid or a similar state-sponsored program of medical assistance for the needy, or use Peace Corps health insurance coverage. … Later, if you lose your other coverage, you may re-enroll in an FEHB plan effective the date coverage was lost. If you do not lose your other coverage but want to re-enroll in an FEHB plan, you may do so during Open Season.” To do that, contact OPM at 1-888-767-6738 or send an email to retire@opm.gov. You can also write to the Retirement Office at: U.S. Office of Personnel Management, Office of Retirement Programs, P.O. Box 45, Boyers, PA 16017.

If you suspend your FEHB self-only coverage, you will receive no benefits from that plan. If you suspend self and family coverage, neither you nor your wife will receive any benefits from it. While you may re-enroll in the FEHB program after canceling your Medicare Advantage enrollment, you may only elect the coverage you had when you suspended it. In other words, if you were enrolled in a self-only option, you may only re-enroll in that. You wouldn’t be able to change to self and family coverage until the next open season.

Medicare Advantage plans are open only to those who are covered by Medicare. Further, there is no such thing as self and family coverage. All Medicare Advantage plans are self only.



About Author

Reg Jones was head of retirement and insurance policy at the Office of Personnel Management. Email your retirement-related questions to fedexperts@federaltimes.com.

Leave A Reply