Q. I’m planning to retire from federal service in 2024. Even though I’ve been using TRICARE health insurance for years thanks to my spouse’s military retirement, I believe that I may enroll in the Federal Employees Health Benefits (FEHB) program during the upcoming Open Season and be able to keep the coverage until I retire. Is that accurate, and if so, what specifics should I know?
A. That is correct. The “five-year test” to continue Federal Employee Health Benefits (FEHB) after retirement is based on time spent under the Uniformed Services Health Benefits Program (also known as TRICARE, CHAMPUS, or CHAMPVA). However, in order to maintain coverage after retirement, you must have an active FEHB enrollment at that time. If you sign up for an FEHB plan during the annual Open Season, keep in mind that most federal employees’ Open Season changes take effect on the first day of the first full pay period, which starts in January. If you were planning to retire soon after the FEHB coverage began, January 31st might be a good day to do so because the last day of the month is typically the best day for most FERS employees to retire.
Retirement plan participants and survivor annuitants may “suspend” their FEHB coverage and premium payments in certain situations, including those covered by TRICARE. You would need to contact OPM for assistance. A rule permits people to cancel their suspension and re-enroll in FEHB at the yearly Open Season or right away in the event that they are forcibly removed from non-FEHB coverage. The survivor annuitant may reenroll in the FEHB program under the same conditions as an annuitant if the annuitant was enrolled in Self and Family or Self Plus One coverage when he or she suspended FEHB coverage and intended to leave a survivor annuity. FEHB coverage and premium payments can be suspended indefinitely. Until they remarry, surviving spouses are still eligible for TRICARE. In that case, losing TRICARE coverage would qualify as a qualifying life event (QLE) and allow reenrollment in FEHB without having to wait for Open Season. A surviving spouse’s FEHB coverage can continue, but it will not cover their new spouse or their dependents. If you lost TRICARE due to a divorce, you could reinstate the suspension of your FEHB coverage with a comparable QLE.
Answer:
Yes, you can have both TRICARE and Federal Employees Health Benefits (FEHB) coverage if you meet certain eligibility requirements. This can be beneficial for several reasons:
Benefits of Having Both TRICARE and FEHB:
- More comprehensive coverage: Combining FEHB with TRICARE can provide you with more comprehensive coverage than either plan alone. For example, FEHB may cover services that TRICARE doesn’t, such as dental and vision care.
- Greater flexibility: Having both plans gives you more flexibility in choosing your healthcare providers. You can use TRICARE for routine care and FEHB for more specialized care.
- Cost savings: In some cases, having both plans may actually save you money. For example, if you have a high deductible FEHB plan, you may be able to use TRICARE to cover some of your costs until you meet your deductible.
Eligibility Requirements:
To be eligible for FEHB coverage, you must be a federal employee or annuitant. You must also meet one of the following requirements:
- You have been enrolled in the FEHB Program from your first opportunity to enroll.
- You have been enrolled in the FEHB Program for the full five years of service immediately preceding retirement.
- You have been enrolled in TRICARE for the full five years of service immediately preceding retirement.
Things to Consider:
- Premiums: You will be responsible for paying premiums for both FEHB and TRICARE.
- Coordination of benefits: If you have both FEHB and TRICARE, you will need to coordinate your benefits to ensure that you are not overpaying for healthcare services.
- Changes in eligibility: Your eligibility for FEHB and TRICARE may change if you retire, leave federal service, or experience other life events.
Additional Resources:
- OPM Retirement Information Center: https://www.opm.gov/retirement/
- FEHB Handbook: https://www.opm.gov/healthcare-insurance/healthcare/fehb-handbook/
- TRICARE Website: https://tricare.mil/
Having both FEHB and TRICARE can provide you with more comprehensive coverage, greater flexibility, and potential cost savings. However, it’s important to consider the premiums, coordination of benefits, and potential changes in eligibility before making a decision.
Frequently Asked Questions (FAQs)
1. Can I enroll in FEHB if I’m already enrolled in TRICARE?
Yes, you can enroll in FEHB even if you’re already enrolled in TRICARE. However, you must meet the eligibility requirements mentioned above.
2. How do I coordinate my benefits between FEHB and TRICARE?
You should contact both FEHB and TRICARE to discuss how to coordinate your benefits. They will be able to provide you with specific instructions on how to file claims and avoid overpaying for healthcare services.
3. What happens to my FEHB coverage if I retire?
If you retire on an immediate annuity in a qualifying retirement system, you can continue your FEHB coverage. However, you may need to pay higher premiums.
4. What happens to my TRICARE coverage if I retire?
If you are eligible for Medicare, you will automatically be enrolled in TRICARE For Life. If you are not eligible for Medicare, you may be able to continue your TRICARE coverage by paying a monthly premium.
5. Where can I find more information about FEHB and TRICARE?
You can find more information about FEHB on the OPM website and more information about TRICARE on the TRICARE website. You can also contact the OPM Retirement Information Center or the TRICARE Contact Center for assistance.
Additional Notes
- This information is for general purposes only and should not be considered as professional advice. You should always consult with a qualified professional before making any decisions about your healthcare coverage.
- The information provided here is accurate as of November 2023. However, eligibility requirements and other details may change over time. It’s always best to check with the official sources for the most up-to-date information.
Disclaimer
I am an AI chatbot and cannot provide financial or medical advice.
Q. I’m planning to retire from federal service in 2024. Even though I’ve been using TRICARE health insurance for years thanks to my spouse’s military retirement, I believe that I may enroll in the Federal Employees Health Benefits (FEHB) program during the upcoming Open Season and be able to keep the coverage until I retire. Is that accurate, and if so, what specifics should I know?
A. That is correct. The “five-year test” to continue Federal Employee Health Benefits (FEHB) after retirement is based on time spent under the Uniformed Services Health Benefits Program (also known as TRICARE, CHAMPUS, or CHAMPVA). However, in order to maintain coverage after retirement, you must have an active FEHB enrollment at that time. If you sign up for an FEHB plan during the annual Open Season, keep in mind that most federal employees’ Open Season changes take effect on the first day of the first full pay period, which starts in January. If you were planning to retire soon after the FEHB coverage began, January 31st might be a good day to do so because the last day of the month is typically the best day for most FERS employees to retire.
Retirement plan participants and survivor annuitants may “suspend” their FEHB coverage and premium payments in certain situations, including those covered by TRICARE. You would need to contact OPM for assistance. A rule permits people to cancel their suspension and re-enroll in FEHB at the yearly Open Season or right away in the event that they are forcibly removed from non-FEHB coverage. The survivor annuitant may reenroll in the FEHB program under the same conditions as an annuitant if the annuitant was enrolled in Self and Family or Self Plus One coverage when he or she suspended FEHB coverage and intended to leave a survivor annuity. FEHB coverage and premium payments can be suspended indefinitely. Until they remarry, surviving spouses are still eligible for TRICARE. In that case, losing TRICARE coverage would qualify as a qualifying life event (QLE) and allow reenrollment in FEHB without having to wait for Open Season. A surviving spouse’s FEHB coverage can continue, but it will not cover their new spouse or their dependents. If you lost TRICARE due to a divorce, you could reinstate the suspension of your FEHB coverage with a comparable QLE.
You may carry over your FEHB coverage into retirement if you were enrolled in the program from the time you first had the opportunity to enroll or for the entire five years of service right before you retired (as long as you retire on an immediate annuity in a qualifying retirement system). ). See the FEHB handbook for more information.
Your FSAFEDS coverage will terminate upon your retirement if you are currently enrolled. Annuitants cannot enroll in FSAFEDS.
This will not affect your FLTCIP coverage. As long as you continue to make premium payments, your coverage will stay in place. To arrange for alternative billing arrangements, call Long Term Care Partners at 1-800-LTCFEDS (1-800-582-3337) if your premiums are paid by payroll deduction. Once your annuity is finalized, you can usually have your premiums deducted from it.
Your time spent being covered by TRICARE, if you have it, counts toward fulfilling this requirement. To maintain coverage, though, you have to be enrolled in a FEHB health plan on the day of retirement. You can ask to have your FEHB enrollment suspended after you retire.
If you had FEGLI coverage for the five years right before you retired, or for the entire time it was available to you if it was less than five years, you are qualified to keep it. Please refer to the FEGLI handbook for more information.