Suspending FEHB coverage

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Q. Federal employees who are veterans with service-connected disabilities and who use the Veterans Health Administration (VHA) for their healthcare are not afforded the opportunity to suspend their Federal Employees Health Benefits (FEHB) upon retirement. This forces those veterans to choose between FEHB, Medicare Part B/C, when they need neither. Is this an Office of Personnel Management policy that can be changed, or does the solution require an act of Congress?

A. By regulation, OPM does allow annuitants to suspend their FEHB enrollment in order to enroll in a Medicare Advantage plan, TRICARE or CHAMPVA, or Medicaid or similar state-sponsored program of medical assistance. (Information on suspending FEHB coverage at  https://www.opm.gov/healthcare-insurance/Guide-Me/Retirees-Survivors/#url=Health.) It doesn’t allow employees to do that, nor does it allow employees or retirees to suspend their FEHB coverage when they are receiving VHA benefits. To change this would require an act of Congress.

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

14 Comments

  1. Karen Mamalakis on

    Great question and I was just waiting until my daughter turned 26 and then I planned to drop my FEHB coverage. So there goes that money saver. My question is what we veterans are too sick to afford our FEHB coverage because mine is very expensive. That’s over $300 a month that I could put in to natural remedies and vitamins which is the only thing helping me at the time.

    • Here is the answer taken from OPM’s website:

      How can annuitants or former spouses suspend FEHB coverage to use TRICARE or CHAMPVA?

      They can apply to suspend their coverage at any time. Annuitants can call OPM’s Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500. Former spouses can get the form from the employing office or retirement system maintaining their enrollment. Eligible individuals must submit a completed suspension form and provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.

      • If we would suspend our FEHB, could we reinstate it at a later date? I cannot afford it; but, if VHA would get bad or the VA would STOP serving us, then I would need FEHB again. Thank you!

        • If you suspended your FEHB coverage and later lost your Tricare or CHAMPVA coverage, you could reactivate your FEHB coverage.

  2. I am a 100% Permanent and Total Service connected Veteran. I am also a retired annuitant paying for FEHB coverage that I don’t need because I receive ALL of my care at my VAMC. I’m only 54 so not enrolling in Medicare for quite some time. I find it very concerning that I have to chose between continuing to pay for coverage I don’t use or cancelling it and never being allowed to re-enroll if I chose to at a later date. Am I reading that wrong or is there a possibility that I can suspend? My wife, a current Gov’t employee who is enrolled in CHAMPVA because of my 100% status is choosing to continue FEHB as a personal choice but has more flexibility in this than I do. Seems silly that I cannot suspend coverage.

    • No, there isn’t any possibility that you could suspend your FEHB coverage. As a lower cost alternatively to a self only enrollment, you could ask your wife to add you to her enrollment during the current open season, which would then be self plus one.

      • We studied that scenario and due to the plan costs for United Healthcare (our chosen FEHB plan) we decided to each do Self Only plans for each of us. We did the math for a few scenarios and honestly it’s the cheaper way to go. Although I’m almost convinced I won’t use the plan outside of the VA I’m not convinced I won’t EVER need it so stopping coverage with no ability to reenroll means I eat the 150.00 a month premium for that piece of mind. I know I could always hop on my wife’s coverage if I cancel and decide to return but that’s only if my wife stays alive and well, none of us are guaranteed to be here tomorrow so best plan for worst case scenario when dealing with health and life.

      • BRIAN STONEBACK on

        Also, just to clarify, an annuitant can suspend coverage while on a spouses FEHB policy and then reenroll at a later date. They just can’t suspend without being on another FEHB, Medicare, Tri-care or ChampVA. However looking at the cost of self /plus one versus self only for her and self only for me; it’s 15$ cheaper even though as an annuitant I can’t take advantage of bi-weekly payments price.

  3. Hello Mr. Jones,
    I need some help. I am retired FERS and have my wife and I enrolled in FEHB (self+1). I’m 61 years of age, but my wife turns 65 this month (November 2018). She is already enrolled in Medicare Advantage plan. I am also a service connected disabled veteran, but do not receive any treatments with VHA. My question is can I suspend my wife FEHB since she is already enrolled in a Medicare Advantage plan? Thank you for your help.

  4. I am not sure why he’s asking about suspending his wife’s FEHB, but if he is already retired and has FEHB, he could just choose Self Only at the next Open Season. If she decides to drop her Advantage plan, he would need to wait until another Open Season in order to elect Self Plus One coverage to cover her again under FEHB.

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