Retired and confused about Medicare Part B? You’re not alone

One of the most confusing issues federal employees face in retirement is the decision to enroll in Medicare. Especially Medicare Part B. The standard premium for Medicare Part B in 2025 is $185/ month. This premium is for individuals with Modified Adjusted Gross Income (MAGI) below $106,000, as shown on your 2023 federal tax return. For a married couple filing a joint tax return, your MAGI must be below $212,000 to pay the standard premium for each spouse (Medicare does not offer self plus one coverage. If your MAGI is over these limits, the premium increases by an additional $74/month or more, depending on how much you are over the MAGI limits. 

Here are some questions related to coordinating Medicare and FEHB that I received from a recent retiree: 

I retired recently and I am 68 years old, so I just started receiving Social Security payments and I registered for Medicare Part A when I turned 65. It is my understanding that I have eight months to apply for Medicare Part B, but what about Part D? Am I required to get Part D, and if I do, does the eight-month window also apply? Also, when should I apply for Part B? Wait until November?  

You may enroll in Part D (prescription drug coverage) with no additional premium through most FEHB carriers. Here is how BC/BS provides Part D: 

We offer Medicare prescription drug benefits to members who have Medicare—the FEP Medicare Prescription Drug Program (MPDP). This is a Medicare Part D plan offered at no added FEP premium cost to members eligible for Medicare. If you are above a certain income level, you may pay an Income-Related Monthly Adjustment Amount (IRMAA) to Social Security for Part D coverage.  

Part D Coverage 

If you are not enrolled in BC/BS, you can find your current FEHB plan by visiting OPM, then click on your state, and on the next screen, click on the link to your plan's website.  Every plan website has a page that explains coordination with Medicare.   

Special Enrollment Period 

You may qualify for a Special Enrollment Period (SEP) for Medicare Part B (outpatient medical coverage) if you are covered by health insurance through you or a spouse’s "current employment." Since you were not paying for Part B through your current employment, you will not be eligible for this SEP. You stated that you have been carrying FEHB through your survivor benefit from your late spouse, which unfortunately means you will be subject to the late enrollment penalty based on the number of 12-month periods that elapsed since the end of your Initial Enrollment Period (IEP). Your IEP started three months before you turned 65 and ended three months after the month you turned 65. For every 12-month period that you delay enrollment in Part B, you may pay a permanent 10% late enrollment penalty. 

I am currently getting health and dental insurance under my deceased husband who was also a federal employee. I am receiving a survivor annuity, so the insurance gets deducted from this benefit. My question is:  Should I continue with BC/BS Basic after I get Medicare Part B? 

If you carry FEHB coverage through a survivor annuity rather than through your or your spouse’s current employment, you may pay a penalty for late enrollment in Medicare Part B. You will need to decide whether to enroll in Part B and pay a late enrollment penalty or continue FEHB coverage without adding Medicare Part B to help offset your out-of-pocket medical expenses along with other incentives offered by some FEHB plans to help encourage enrollment in Medicare.   

There is no premium for Medicare Part A, and for individuals who didn’t enroll during their IEP, they can sign up for Part A any time after turning 65. Part A coverage starts six months back from when you sign up or when you apply for benefits from Social Security (or the Railroad Retirement Board). Coverage can’t start earlier than the month you turned 65. 

There are many FEHB plans that provide incentives to enroll in Medicare Parts A and B and BC/BS Basic Option is one of them. BC/BS Basic (enrollment codes 111, 112, 113) will waive your out-of-pocket copays and coinsurance when Medicare A or B are the primary payer of your inpatient (Part A) or outpatient (Part B) medical care. This plan also provides Medicare prescription drug coverage (Part D) and a Part B reimbursement of $800 annually (per individual enrolled in Part B). Other fee-for-service FEHB plans providing a partial rebate for Part B include:   

• Aetna Direct ($900 annual Part B reimbursement per Part B-enrolled individual) (plan codes N61, N62, N63) 

• GEHA High Option ($1,000 annual Part B reimbursement per Part B-enrolled individual) (plan codes 311, 312, 313)      

Many FEHB plans, in addition to the three plans mentioned above, will waive the plan’s cost-sharing (deductible, copayments, and coinsurance) when Medicare is the primary payer.   

There are FEHB plans that provide a reduction (rather than a rebate/reimbursement) in your Medicare Part B premium if you enroll in a Medicare Advantage option offered by the plan. Medicare Advantage plans are another name for Medicare Part C. These are plans that take a total approach to your health by covering your doctors, hospitalization and prescription drugs in one simple plan. You’ll also get access to programs that may help you reach your health potential, such as vision, hearing, dental coverage or a fitness membership such as SilverSneakers® that vary by plan. And you can continue to use your doctors, or any provider, if they are: 

• Eligible to receive payment under Medicare 

• Willing to bill and accept payment from the plan 

There is no additional cost to enroll in an FEHB Medicare Advantage plan. You continue to pay your FEHB Plan premium and Medicare Part B premium. Once you enroll in an FEHB plan offering a Medicare Advantage option, you must complete a second enrollment to “opt into” the Medicare Advantage option by contacting the FEHB Plan.  Most FEHB carriers offer a Medicare Advantage enhancement (but not BC/BS), including the majority of FEHB Health Maintenance Organization (HMO) plans. 

My next question is that I plan to move to another state in a few months. Will that have any impact on Medicare Parts B and D? 

Medicare provides nationwide coverage; you can use it in all 50 states and U.S. territories. There are some limited exceptions that would allow you to get coverage outside the U.S. under Medicare Part A (Hospital Insurance) and or Part B (Medical Insurance). Visit Medicare.gov/coverage to find out what Medicare covers orcall 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048 

If you are enrolled in an FEHB HMO plan and you move, you may change your enrollment to a nationwide plan or another HMO plan that provides service in your new area. Also, you may change your enrollment if an enrolled family member moves outside the service area.  

If you are enrolled in a nationwide FEHB plan, you will have coverage even if you move outside the United States. Some notes about FEHB coverage if you decide to permanently move outside of the United States or its territories: 

• You should not be enrolled in an HMO if you are living overseas, except when the overseas geographic location is part of an HMO's service area (such as Guam). 

• See Section 7 of your FEHB plan brochure for information about filing an overseas claim.  Most overseas providers require payment "up front".  Some plans pay overseas providers as at the Preferred Providers benefit level, but you will probably have to pay the difference between the plan payment and the actual charge. Check to see whether you must provide an English translation of the bill (claim) and currency conversion information. 

Once retired, don't forget that you must notify OPM if you move.  To change your mailing address with the Office of Personnel Management, you should sign in to your online account by visiting OPM Retirement Services Online and then click Profile in the menu; then click the Communication tab and then click Change in the Home Address section. On this page, you can also update your phone number, email address, and communication preferences.  OPM says to allow a couple of days to show the changes before contacting them.  Make sure you save your changes before leaving the page. 

To learn more about coordination of Medicare with an FEHB or PSHB plan, see the following articles: 

• Medicare quiz for federal retirees 

• 10 important facts about Medicare 

• Mixed reactions to Medicare Part D in the FEHB 

• How to decide if Medicare Part D is right for you 

• Medicare Part D may benefit most federal annuitants next year 

• Open Season: Medicare Advantage or Disadvantage? 

• Before asking for help, know the rules 

• An employee group is miffed by the new Postal Service insurance program’s Medicare Part D coverage 

• Age gap retirement planning for federal employees: Avoiding the 'Widow’s Penalty,' Medicare planning and more 

• The Postal Service Health Benefits program, prescription coverage and Open Season 2025