FEHB and Tricare

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Q. My wife and I are retired federal workers and currently enrolled in FEHB. I will be eligible for Tricare in January 2020. Do I to wait for next open season to be able to cancel/suspend FEHB coverage or can I cancel/suspend when I become Tricare Eligible?

A. According to OPM, “If the documentation showing your eligibility for TRICARE is received within the period beginning 31 days before and ending 31 days after the date you designate as the day you want to use TRICARE or CHAMPVA instead of FEHB coverage, the suspension becomes effective at the end of the day before the day you designated.”

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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.

36 Comments

  1. Joseph Chadwell on

    I’m assuming your a retired reservist. Just my thoughts as being retired military myself. 1) Understand how Tricare works I.E. will you be Tricare Select or Tricare Prime. 2) Know the cost.
    3) Look at a cheaper FEHB plan that can be used with Tricare until age 65 when you are eligible for Medicare. 4) Talk to other military retirees that you might know and see what they’re doing. Good luck.

  2. I also will be retiring as an 1895 in 2024 and am retired military reserves and OPM says I can’t use tricare but tricare says I can. so who is right?

    I also want to know if I can’t use tricare because i am an active federal employee how long after retiring from civil service can I use tricare and how does that work with medicare?

    • OPM has no say in the matter. Only Tricare can tell you whether you can use those services while a civil service employee.

    • I work with many retired military, both Active Duty retired and Reserve retired, at DOD in Civil Service. Most of them use Tricare. Most don’t sign up for an FEHB plan, but can if they want. A couple also have Medicare. So, whoever you talked to at OPM (more likely, it was local HR) doesn’t know what they’re talking about. Also, you are required to sign up for Medicare Part B if you have Tricare. Until you retire from Civil Service, either Tricare or FEHB are primary and Medicare is secondary; once you retire from Civil Service, then Medicare is primary and either Tricare or FEHB are secondary.

      • I currently have FEHB however, I also had Tricare but on my birthday this year I turned 65; at that time Tricare cancel me because I did not sign up for Medicare B because I am still working for the federal government full time. Having FEHB and Tricare helped with the co-payments.

        Question: when I retire can I have Medicare B (80%) and (20%) Tri care and FEHB.

        • Yes, you can. However, when you are covered by Tricare and Medicare Part B, you may want to consider waiving – not cancelling – your FEHB coverage. Many retirees with the same combination of benefits have told me that their medical needs are fully covered by Tricare and Medicare and, therefore, they don’t need to continue their FEHB enrollment. Waiving your FEHB coverage would allow you to reenroll in that benefit if things change.

  3. Kenneth Sullivan on

    I believe someone had to have asked this question by now, Can I use FEHB for any “donut hole” that TRICARE doesn’t cover?

    • As long as you are enrolled in both Tricare and an FEHB plan, what one plan doesn’t cover, the other may. You’ll need to compare both plans to see where they differ and check for any gaps.

  4. Hello Reg – I have been a federal employee for the last 29+ years and have been enrolled in an FEHB plan. I retired from the AF Reserves a few years ago and have been enrolled in TRICARE Select since I turned 60. I plan to retire as a federal employee when I turn 63, which will be July 2021, next year. Which health plan should I keep/drop/suspend for my wife and me? I’ve been reading/researching on the Internet, but no answers have been straight forward.

    • You should enroll in a low-cost FEHB plan during the up-coming Open Season. Then when you retire you can suspend that coverage in favor of Tricare. That way you’d be able to reactivate your FEHB coverage if Tricare no longer meets your needs.

  5. I am retiring from federal service in Feb 2021. I am currently using tricare for life and medicare and am not signed up for FEHB. At a retirement briefing they mentioned it would be good to sign up for FEHB prior to retirement and then suspend FEHB once I retired from federal service. What is the advantage of this. Once I enroll in FEHB how will my insurance be handled (what will be prime and what will be secondary, Medicare, Tricare for Life and FEHB). If I sign up for FEHB to start at the beginning of the year when and how do I submit the paperwork to suspend it.

    Thanks

      • Ok I am still working enrolling in FEHB this enrollment season (coverage should start on 1 Jan. I am retiring on 27 Feb next year. I am currently on Medicare and Tricare for life. Once my FEHB coverage starts next year. when can I suspend it because I am on Tricare for life and Medicare. Until I suspend it what is the order of the Insurance (Medicare – primary, tricare for life secondary, FEHB ?) Checked out the link above but could not find answers to these questions.

        Thanks

        • There is no simple answer to your question. Here’s why. If you are covered by FEHB and Tricare, FEHB pays first. That changes when Medicare enters the picture. Medicare makes the case-by-case determination of who pays first.

  6. Joseph Milligan on

    Once an eligible annuitant and also retired military person suspends FEHB in favor of Tricare, doe the eligibility to return to FEHB ever expire? Is there a time limit? Also, if an annuitant returns to FEHB for a few years, but then wants to suspend FEHB a second time (presuming eligibility to return to Tricare remains), is that permitted. Thanks.

    • The eligibility to return to FEHB coverage doesn’t expire. I’m not aware of any impediment to your suspending your FEHB coverage for a second time; however, you’ll need to find out if there is any bar to your re-enrolling in Tricare.

  7. So I am going to retire next year and have FEHB and Tricare select currently, We still have a 19 year old dependent. Am I correct in that she can stay on FEHB until age 26, but if we only keep Tricare she is dropped at age 22. I am retiring at age 62 so no Medicare yet. I think I will need to keep FEHB just so she can stay on insurance longer? Or could I suspend FEHB and then pick it back up when she is 22 so she has coverage?

    Both my husband and I are Veterans, I am the retired Veteran.

    • Since you use the pronoun “we,” I have to assume that you are referring to you and your spouse. If you continue to be enrolled in the Self and Family option, your dependent would also be covered. if you switched to Self Plus One and the “one” was your spouse, your dependent would immediately lose coverage. She could be re-included during any FEHB Open Season by switching to Self and Family. If you suspended your FEHB coverage in favor of Tricare, she would no longer be entitled to any health benefits coverage. Note: I’ve written “suspended” because it would allow you to reactivate your FEHB coverage at a later date. If you cancelled it, you wouldn’t be able to do that.

  8. Current federal employee with FEHB and Tricare Select. Is my spouse eligible for FEHB after I retire from federal service as long as I’m living but don’t leave survivor benefit? And, if I suspend FEHB, is spouse still eligible for FEHB if I re-activate it should Tricare Select not meet our needs. And, should I keep FEHB for spouse and myself along with Tricare Select?

    • As long as you are enrolled in the Self Plus One or Self and Family option, your spouse will continue to be covered by the FEHB program. However, if you don’t provide a survivor benefit – which you must do under the law unless your wife agrees in writing to be excluded from coverage – her entitlement to FEHB coverage will end. If you suspend FEHB coverage, your wife will no longer be covered under the program; however, if you reactivate that coverage, she will be. The decision to continue your FEHB coverage along with Tricare Select is a decision you’ll have to make. As noted in the previous sentence, whether you continue active coverage ion the FEHB program will largely depend on your wife’s needs.

  9. I am retired federal civil service with FEHB and retired Air Force with Tricare Select (which we now have to pay a small monthly premium for). I’m 4 months from 65 and I’ve read that if I don’t take Part B Medicare, I would lose the Tricare. Is that true, even though I’m paying a premium for it now and it is not my primary insurance?

      • Thanks Reg, that’s a bummer. I have the perfect coverage with FEHB and Tricare as backup. I never have to pay anything out of pocket no matter what I have done and I’ve been in the hospital several times for big money items since I retired at age 56.

        I don’t like the idea of waiving FEHB because it is such a good insurance.

        Since I can afford it, would it make sense to get Medicare Part B, keep FEHB and Tricare. That way I should be covered for about anything that should come my way. I know my FEHB monthly premium is less expensive (and probably better coverage) than any Medicare Part C plan?

        • I guess I’m asking if it is worthwhile to take Medicare Part B so I can keep Tricare for Life and also have FEHB at the same time or do you think that is overkill?

          • If you enroll in Tricare for Life, you should suspend – not drop – your FEHB coverage. That way you’d be able to reactivate that coverage if you ever decided to drop Tricare.

  10. I keep looking at this, and I think I’m going to take Medicare Part B, keep FEHB going and also have TFL. I take a lot of pills and don’t want to use a mail in pharmacy like Express Scripts. So it would be more to my advantage to keep FEHB for my local pharmacy and TFL as the backup as Tricare Select is right now. As it is, I take 10 pills daily and only pay $15 dollars every 90 days for all 10 pills. If I wanted to use just TFL and use my local pharmacy, it would cost $390 every 90 days for those 10 prescriptions. Also, Medicare Part B doesn’t cover dental and vision, whereas my FEHB plan does. I’m just thinking for me, and for convenience of the pharmacy, I’m better off not suspending FEHB at this time, but I always can if I decide to in the future.

    • You’ve done a good job of weighing the alternatives and coming up with a solution that works for you. Congratulations!

  11. Andrew Breithaupt on

    Here’s a complicated one: I’m a federal “special category employee” eligible for immediate full FERS retirement at age 52 in my case (This year). I’m also a drilling Army reservist eligible for Tricare reserve (if I suspend FEHB as I understand it). My question surrounds opting out of survivor benefits for my spouse in lieu of a term life policy at a much cheaper rate than the 10% or 5% percent survivor cost each month on my annuity. In our particular financial case that part makes sense…the issue is health insurance for my spouse/children if I die early in retirement and continued coverage. I think Tricare or FEHB would be fine for our needs, healthy no issues.

    But if we opt out entirely of FERS survivor benefit family would have zero coverage on my death and can’t switch to Tricare at that point either. I’m planning to reserve drill until age 60 when I will begin drawing regular military retirement benefits. We already opted in on the military survivor benefits for spouse from my reserve career and it’s immediate on my death even if before 60. If i retire in FERS, can I suspend FEHB, then enroll Tricare Reserve and family keep it even after my death before 60 since military survivor benefits start immediately for her?

    The language about “must not be eligible or enrolled in FEHB” at the time to enroll in Tricare confuses me. Because if i suspend FEHB in retirement…am I not still “eligible” and therefore not able to enroll in Tricare reserve?

  12. WARNING: I’d like to warn folks about I problem I have encountered in suspending my FEHB (Blue/Cross Federal) and using my Tricare, earned at age 60 as a retired reservist. At first I thought “suspending” my FEHB and making Tricare my only medical insurance at the point of my federal retirement was a no brainer. I was wrong! I quickly learned that three (3) speciality prescriptions I was receiving under my Blue Cross (with a small co-pay) would not be covered at all by Tricare. These three medicines require “prior approval” from Tricare and all three were DENIED by Tricare’s prior approval. To pay out of pocket for these medications would cost me more than $1,500 per month. The co-pay for all three of these medicines under Blue Cross is $60 per month. So, I’m going back to Blue Cross at the next open season. Because of this my Tricare is worthless to me. Anyone have similar problems?

    • PS- all three of those specialty medicines discussed above ARE in the DoD formulary. They are not some exotic “compound.” They are heart medications commonly prescribed by cardiologists.

  13. wow, I am glad I read this, I am also a retired reservist, turned 60 this year and also retired FERS this year. My spouse and I also considered me suspending my FEHB and picking up Tricare but I have had some reservations about doing so, especially since we are still overseas (spouse still employed for DoD). I received a notice from OPM that they needed proof of my eligibility for Tricare before they could suspend my FEHB. I was going to tell them not to cancel but my spouse is going to just add me to his FEHB during open season next month so I am going to suspend my FEHB but not pick up the Tricare at this time. Also, in my honest opinion, the vision is not great with FEDVIP so we will skip that but the dental does help pick up some of the costs so we will go with dental. This insurance business is just so darn confusing and I am NOT looking forward to when I have to deal with the Medicare part!

  14. OK – Looks like a lot of the same issues, worded differently, but here it goes again. I’m a retired FERS with FEHB paying premiums of approximately $600/month, and a retired Military Reservist with Tricare Select paying $25/month. And I’m 62 years of age and wanting to find out my best options at age 65, the dreaded Medicare options. I love my current double coverage because I pay absolutely nothing out of pocket for me and my wife medical checkups, exams, and prescriptions. My question is: If I suspend FEHB at age 65, and use my TRIICARE For Life to handle Medicare part B, will this Medicare/Tricare coverage provide the same no cost out of pocket expense at age 65?

    • Unfortunately, I’m only able to confidently answer questions about FEHB benefits, less confidently about Medicare, and not at all about Tricare. As a result, I can’t answer your question.

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