Federal Employee Health Benefits (FEHB) Prescription Drug A prescription drug is a drug that can be obtained only if you have a prescription from a provider. Prescription drugs cannot be bought over the counter.  coverage is creditable for 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). -eligible retirees. This means that if you are enrolled in FEHB, you can delay Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. Enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan.  without incurring a late enrollment penalty (LEP). Be sure to compare the costs and benefits of your FEHB plan and Part D to decide which best suits your needs.
If you are eligible for Extra Help, you may want to consider enrolling in Part D. The drug copayments for individuals who have Part D and Extra Help Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program administered by Social Security that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, including coinsurances, deductibles, and premiums. People with Medicare who have income and assets below specified limits are eligible for Extra Help, which has different levels. Depending on your income and assets, you may qualify for either full Extra Help or partial Extra Help. People may also be automatically enrolled in Extra Help if they have certain other types of coverage, even if their income and assets are above the set levels. are typically lower than the copays under FEHB drug coverage. However, your FEHB plan’s Formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. may be broader than the formularies of Part D plans offered in your area. You may also want to keep FEHB drug coverage if the plan covers your drugs with no or fewer Coverage Restrictions Coverage restrictions, also called Utilization Management Tools or formulary restrictions, are restrictions that a health or drug plan may place on certain covered services to limit their usage. Coverage restrictions include prior authorization, quantity limits, and step therapy.  than available Part D plans.
If you enroll in both Part D and FEHB drug coverage, Part D is typically the primary payer for your Prescription A prescription is an order for a health care service or drug written by a qualified health care professional.  drugs.
Note: FEHB drug coverage cannot be suspended separately from FEHB health coverage. If you want to keep your FEHB health coverage, you must keep drug coverage, even if you enroll in Part D.