Medicare and FEHB Enrollment for CSRS Retirees: A Comprehensive Guide

Medicare is a federal health insurance program for those who are 65 years of age or older, as well as some younger disabled individuals and those who have kidney failure. Part A provides financial assistance for home health, hospice care, skilled nursing facility care, and hospital care. Part B provides financial assistance for outpatient hospital care, doctor bills, and other medical services that are not covered by Part A. Medicare Advantage, a program offering alternative medical care options, is also referred to as Part C, and Part D is the name of the prescription drug benefit program.

Federal workers who participate in the FERS and CSRS/CSRS Offset retirement plans receive one 45 percent of pay and be qualified for benefits using the same guidelines as other American workers

If you or your spouse held a Medicare-covered job for ten years or more, are 65 years of age, and are a citizen or lawful permanent resident of the United States, you qualify. If you have a chronic kidney disease or are a younger person with a disability, you may also be eligible for coverage. Here are the basic guidelines:

You are eligible to receive Part A without paying premiums if you are under 65 if:

If any of those conditions apply to you, you are not required to pay a premium for Part A; however, if you desire Part B, you will need to pay for it. The standard Part B monthly premium is $174. 70 (in 2024). For retirees with high incomes, there is a surcharge that increases with income level. Payments from Social Security or civil service retirement are withheld to cover the premium.

Note: By paying a monthly premium, individuals who were only eligible for Medicare because of a kidney transplant but would lose their entire eligibility 36 months after the transplant could choose to keep receiving Part B coverage for immunosuppressive medications. Most will pay $103 in 2024, but higher-income enrollees will pay more.

Call the Social Security Administration at (800) 772-1213 if you have questions about your eligibility for Medicare Part A or Part B, or if you would like to apply for Medicare online at www. medicare. gov. If you are not eligible for premium-free Part A, you can also obtain information about purchasing Part B and Part A.

You do not need to apply if you are receiving Railroad Retirement or Social Security benefits when you turn 65. Your Medicare card is mailed to you approximately three months prior to your 65th birthday, and you are automatically enrolled in both Part A and Part B. If you would like to opt out of Part B, please refer to the card’s instructions.

If you qualify for disability benefits from Social Security or Railroad Retirement Board, you will automatically receive a Medicare card in the mail after receiving benefits for 24 months.

Three months prior to turning 65, if you are not receiving Social Security or Railroad Retirement benefits, you must apply for Medicare. To apply, get in touch with any Social Security Administration office or the Railroad Retirement Board if you or your spouse were railroad employees. Apply three months before you turn 65.

That’s the beginning of your seven-month initial enrollment period. Applying ahead of time will help you avoid having your Part B coverage begin later than expected. You will have to wait until the following general enrollment period to enroll if you choose not to enroll during this seven-month window. Every year, general enrollment runs from January 1 to March 31. Part B coverage begins in July of that same year.

Don’t put off enrolling. In general, your premiums will be higher if you wait more than a year to sign up.

For every 12 months that you could have been enrolled but were not, your Part B premiums increase by 10%. No matter how late you enroll for coverage, the increase in Part A premiums (if you are required to pay a premium) is 10%.

However, there are some situations in which you can postpone enrolling in Part B without incurring higher premiums. There are two options available to you if you are 65 years of age or older and have group health insurance based on your current employment or the employment of your spouse, or if you are disabled and have group health insurance based on your current employment or the current employment of any family member:

You will have to wait until the following general enrollment period, which starts on January 1st of the following year, if you do not enroll by the end of the eight-month period.

If you work after you turn 65, you should enroll in Medicare Part A at the very least. If your employer’s plan does not cover all of your costs, Part A might help. But enrolling in Part B at the same time might not be the best idea. As long as the employer plan was the main source of payment for your medical bills, you would be required to pay the monthly Part B premium and the Part B benefits would have limited value. Moreover, you would trigger your six-month Medigap open enrollment period.

How you will receive your Medicare hospital and medical benefits is one crucial choice you may have to make. Medicare Advantage, also known as Medicare Part C, offers Medicare-eligible individuals a wider selection of health plans in addition to the Original Medicare fee-for-service structure. These plans include medical savings accounts, preferred provider organizations, provider sponsored organizations, and private fee-for-service plans.

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As a CSRS retiree approaching the age of 65, you may be wondering how Medicare and the Federal Employees Health Benefits (FEHB) Program will work together to provide you with health insurance coverage. This guide will answer your questions about Medicare and FEHB enrollment, helping you make informed decisions about your healthcare options.

Understanding Medicare and FEHB

Medicare: A federal health insurance program for individuals aged 65 and older, as well as certain younger individuals with disabilities and those with End-Stage Renal Disease (ESRD). It consists of four parts:

  • Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Part B (Medical Insurance): Covers doctor’s services, outpatient hospital care, ambulance services, durable medical equipment, and some preventive services.
  • Part C (Medicare Advantage Plans): Offered by private insurance companies, these plans provide all Part A and Part B benefits, and may also include prescription drug coverage and additional benefits.
  • Part D (Medicare Prescription Drug Plan): Provides coverage for prescription drugs.

FEHB Program: A government-sponsored program that offers health insurance plans to federal employees, retirees, and their families. It offers a wide variety of plans with different coverage levels and premiums.

Medicare and FEHB Enrollment for CSRS Retirees

Medicare Eligibility:

  • You are automatically eligible for Medicare Part A at age 65 if you or your spouse worked for at least 10 years in Medicare-covered employment.
  • You must pay a monthly premium for Medicare Part B.
  • You must enroll in both Medicare Parts A and B before you can enroll in Part C or Part D.

FEHB Enrollment:

  • You can enroll in any FEHB plan or option during the annual Open Season or during a special enrollment period.
  • You can change your FEHB enrollment to any available plan or option at any time beginning 30 days before you become eligible for Medicare.
  • You may make this enrollment change only once.

Coordinating Medicare and FEHB Benefits

  • If you are enrolled in both Medicare and FEHB, Medicare will be the primary payer for most covered services.
  • FEHB will pay for covered services after Medicare has paid its share.
  • Your FEHB premiums will not reduce if you enroll in Medicare.

Making Informed Decisions

  • Review the Medicare & You handbook and the FEHB Handbook for detailed information about benefits and coverage.
  • Consider your individual health needs and budget when choosing between Medicare and FEHB plans.
  • Consult with a health insurance professional or benefits counselor for personalized guidance.

Additional Resources

By understanding Medicare and FEHB enrollment options, CSRS retirees can make informed decisions about their health insurance coverage. This guide provides a starting point for further research and consultation with relevant resources to ensure optimal healthcare coverage in retirement.

Medicare Part A Benefits

When all eligibility criteria are satisfied, Medicare Part A assists with funding:

  • care in a hospital;
  • care in a skilled nursing facility following a hospital stay;
  • home health care;
  • hospice care; and
  • blood, after the first three pints.

Benefit periods are used to measure how long hospital and skilled nursing facility coverage lasts. The number of days that Medicare will contribute to the cost of inpatient hospital and skilled nursing facility care is limited for each benefit period. If you go over the allotted amount, you will be charged for each extra day of care.

The day you are admitted to the hospital marks the start of your benefit period. When you leave a hospital or skilled nursing facility for 60 days in a row, it comes to an end. It also expires if you are receiving skilled care in a skilled nursing facility but have not had any skilled care for 60 days in a row.

Your hospital and skilled nursing facility benefits are renewed upon your subsequent hospital admission, marking the start of a new benefit period. The number of benefit periods you can have is unlimited.

Medicare Part A helps cover up to 90 days of medically necessary care in a Medicare-certified hospital during a benefit period if you require inpatient hospital care.

Medicare covers all eligible expenses for the first sixty days, with the exception of the $1,556 hospital deductible. No matter how many times you visit the hospital during a benefit period, you only have to pay the deductible once.

Medicare covers all eligible expenses from the 61st to the 90th day of a benefit period, with the exception of coinsurance, which is $389 per day. The coinsurance amount is $778 per day after the ninety-first day. You are responsible for paying the coinsurance.

The Original Medicare Plan

This health care plan is also known as “fee-for-service. It is provided by the federal government and accessible across the country. Generally, there is a cost associated with each health care service or item you receive. You can purchase a Medigap policy to help with the costs that the original plan does not cover (supplemental insurance) Gaps in the original Medicare plan coverage are filled by a Medigap policy; for federal retirees, FEHB essentially plays this role.

Available in many areas, Medicare Advantage Plans include:

  • Medicare Managed Care Plans: Unless there is an emergency, you can only visit physicians, specialists, or hospitals on the plan’s list under most managed care plans. All Medicare Part A and Part B medical expenses must be covered by plans. Certain managed care plans provide additional benefits, such as longer hospital stays. You might pay less than you would have with the Original Medicare Plan.
  • Medicare Preferred Provider Organization Plans (PPO): This kind of plan allows you to use network providers, hospitals, and physicians. For a fee, you can use physicians, hospitals, and other providers who are not part of the network.
  • Medicare Private Fee-for-Service Plans: These plans allow you to visit any hospital or physician who is approved by Medicare and accepts the plan’s payment. The insurance plan determines how much it will pay and how much you must pay for the services you receive, not the Medicare program. You may pay more or less for covered benefits. There are additional benefits that the Original Medicare Plan does not cover.
  • Medicare Specialty Plans: A particular kind of plan that offers certain individuals more specialized medical care These plans cover all of Medicare’s benefits as well as additional, targeted treatment for conditions like diabetes, end-stage renal disease, and congestive heart failure.

If you choose to enroll in a Medicare Advantage Plan, you will pay for medical services using the health card that your Medicare Advantage Plan (provider) issues. These plans frequently offer you more options as well as additional benefits, such as longer hospital stays.

You don’t need a Medigap policy if you have a Medicare Advantage Plan because these plans typically cover many of the same benefits as Medigap policies, such as additional hospital days after you’ve used up your allotted number of days that Medicare pays for.

You remain a participant in the Medicare program regardless of how you receive your benefits. All Medicare Part A and Part B covered services are provided as long as you pay the monthly Medicare Part B premium in any Medicare health plan.

Medicare beneficiaries can choose from a variety of options by using the government-posted plan-by-plan comparisons available at www. medicare. gov.

Federal Employee Retirement Health Benefits and Medicare


Do most federal retirees enroll in Medicare Part B?

About 70% of federal retirees enroll in Part B, which means paying two premiums and in essence two duplicative insurance programs.

Do I need Medicare Part B if I have federal Blue Cross?

You don’t have to take Part B coverage if you don’t want it, and your FEHB plan can’t require you to take it. There are some advantages to enrolling in Part B: You must be enrolled in Parts A and B to join a Medicare Advantage plan.

Do CSRS employees pay into Medicare?

Employees share in the expense of the annuities to which they become entitled. CSRS covered employees contribute 7, 7.5, or 8 percent of pay to CSRS and, while they generally pay no Social Security retirement, survivor and disability (OASDI) tax, they must pay the Medicare tax (currently 1.45 percent of pay).

When did federal employees start paying into Medicare?

Jane retired under CSRS, and she did not have enough work credits to qualify for Social Security retirement benefits, however, all federal employees who paid the Medicare tax are eligible for Medicare on their work record and feds have been paying into Medicare since 1983.

Are CSRS employees eligible for Medicare?

Nor are CSRS employees who retired after that date but before having Medicare deductions taken from their pay for 10 years. On the other hand, they are eligible to enroll in Medicare Part B, which is open to everyone 65 or older. Reg Jones was head of retirement and insurance policy at the Office of Personnel Management.

What does CSRS stand for?

It was replaced by the Federal Employees Retirement System (FERS) for Federal employees who first entered covered service on and after January 1, 1987. The Civil Service Retirement System (CSRS) is a defined benefit, contributory retirement system. Employees share in the expense of the annuities to which they become entitled.

How does CSRS work?

The employing agency matches the employee’s CSRS contributions. CSRS employees may increase their earned annuity by contributing up to 10 percent of the basic pay for their creditable service to a voluntary contribution account. Employees may also contribute a portion of pay to the Thrift Savings Plan (TSP) (external link) .

Can employees contribute to the CSRS?

Employees may also contribute a portion of pay to the Thrift Savings Plan (TSP) (external link) . There is no Government contribution, but the employee contributions are tax-deferred. This section of the website covers the Civil Service Retirement System (CSRS).

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