Federal Employee Health Benefit (FEHB) plans cover current and retired government employees. They are administered by the Office of Personnel Management (OPM).
FEHB plans can be either Health Maintenance Organizations (HMOs) or Fee-for-Service Fee-for-service is payment to providers for each service they provide, as in Original Medicare. (FFS) plans. HMOs have networks of providers, and you must usually see In-Network In-network means part of a private health plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and durable medical equipment suppliers that are in your Medicare Advantage Plan or Part D plan’s network, you will generally pay less than if you go to out-of-network providers. providers to be sure services are covered. In an HMO, your Out-of-Pocket Costs Out-of-pocket costs are health care costs that you must pay because Medicare or other health insurance does not cover them. may be lower than in other plan types. FFS plans allow you to see any medical Provider See Health Care Provider. , but you may have higher costs.
FEHB plans follow some of the same Coordination of Benefits Coordination of benefits is how Medicare and other health insurance share responsibility for paying claims. Your primary insurance and secondary insurance must follow particular rules to coordinate benefits and pay claims.  rules and rules for delaying Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). Enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan.  as non-federal job-based insurance and retiree insurance— with a few important exceptions. Because you or your spouse work for the federal government—an employer with 100+ employees—FEHB is always primary during active employment. Additionally, if you meet other requirements, you will have a Special Enrollment Period (SEP) to enroll in Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. when you are no longer covered by FEHB insurance based on Current Work One of the qualifications for the Part B Special Enrollment Period is to be currently working. You are considered to be currently working as long as you have employment rights at your company even if you do not work on a regular basis, are on sick leave, are a seasonal worker, or have been temporarily laid-off. You are not considered to be currently working if you receive Social Security Disability Insurance (SSDI), have received disability benefits from your employer for more than six months, or if you receive your employer insurance through COBRA. .
If you are entitled to FEHB Retiree Insurance Retiree insurance is health insurance provided by employers to former employees who have retired. Retiree insurance almost always pays secondary to Medicare. See also: Secondary Insurance.  based on your or your spouse’s previous job, you do not have an SEP. When you become Medicare-eligible, you can:
- Decide to keep FEHB and enroll in Medicare Parts A and B.
- Disenroll from your FEHB coverage and enroll in Medicare.
- Turn down Medicare Part B and keep FEHB.
Unlike other retiree insurance, FEHB will pay primary if you do not enroll in Part B. Therefore, in any of these cases, you will have primary coverage. However, you should consider each option and your Health Insurance Health insurance (sometimes called health coverage) pays for some or all of the cost of health services you receive, like doctors’ visits and hospital stays. Programs like Medicare and Medicaid are public health insurance offered through the government. Health insurance can also be administered by private companies that offer individual policies, group health plans, and supplemental insurance.  needs before deciding whether or not to delay Medicare enrollment.