HealthCare
The Federal Employees Health Benefits Program (FEHB) is a voluntary program which provides protection against the cost of health care services for federal employees and their families. It also includes coverage for prolonged illness or serious accidents. The cost of FEHB premiums is shared by federal workers and the government.
Requirements
There is no medical check requirement to join FEHB. You can choose from PPO, POS, or HMO plans.
Cost
The Government Pays between 72% and 75% of the total premiums. You pay your share of the premium through payroll deductions while working and in retirement
Coverage
Continued coverage based on the plan that you have elected, during Open Season.
In Retirement
You are normally required to have FEHB coverage for the 5 years before you retire from federal service
Features
Each plan brochure will tell you what services and supplies are covered and the level of coverage. Be sure to review the brochure thoroughly.
Open Season
Generally from November to December you are able to enroll and change coverage. Though other qualifying life events may allow you to change coverage throughout the year.
Requirements
You must be one of the following:
– Active duty service member
– National Guard/Reserve member
Retiree
– Family member of a service member or retiree
– Survivor of a deceased service member
– Medal of Honor recipient or family member
– Registered in DEERS (Defense Enrollment Eligibility Reporting System)
Cost
TRICARE Reserve Select $53.80 (Mem) – $274.48 (Fam)
TRICARE Retired Reserve – $631.26(Mem) $1,513.04 (Fam)
TRICARE Young Adult Prime – $727(Mem)
TRICARE Young Adult Select – $337
Coverage
When health care services are only covered by TRICARE, Medicare pays nothing. You’re responsible for paying the TRICARE deductible and cost-shares. Medicare doesn’t pay for health care services you receive from providers who opt out of Medicare. When you see an opt-out provider, TRICARE pays the amount it would have paid (normally up to 20% of the TRICARE-allowable charge), if Medicare had processed the claim. You’re then responsible for paying the remainder of the billed charges. The Department of Veterans Affairs providers can’t bill Medicare, and Medicare can’t pay for services received from the VA.
In Retirement
For retired military to keep TRICARE in retirement:
– You must have 20 or more years of service.
– You and your dependents must be enrolled in Medicare Part B if over age 65 (for TRICARE For Life).
– Must continue to be listed in DEERS as retired.
Features
TRICARE Prime (Managed Care / Lowest Out‑of‑Pocket)
Enrolls you with a Primary Care Manager (PCM) who provides or coordinates most care; referrals generally required for specialty care; strong cost protection and typically lowest out‑of‑pocket when you follow plan rules; access standards apply in Prime Service Areas.
TRICARE Select (PPO‑Style Flexibility)
Greater provider choice: see any TRICARE‑authorized (network or non‑network) provider—referrals usually not required, though some services need prior auth; costs vary by network status and you may pay up front and file for reimbursement when using non‑network care; deductibles and cost‑shares apply.
TRICARE For Life (TFL) – Medicare Wraparound
Automatic when you’re TRICARE‑eligible and enrolled in Medicare Parts A & B (typically at 65); Medicare pays first, TRICARE pays second for overlapping covered services, often leaving you with little or no out‑of‑pocket; overseas (where Medicare doesn’t pay) TRICARE becomes primary after deductibles/cost‑shares; includes TRICARE Pharmacy coverage so a separate Part D plan is usually unnecessary
Tricare + FEHB
Tricare coverage can be used in place of FEHB in retirement and can also be used to meet the 5 year requirement for FEHB
But you must be enrolled in FEHB at the time of retirement
Tricare only retirees will have to sign up for Medicare part B when first eligible
Requirements
Age 65: Core eligibility; most people qualify at 65. Some are auto‑enrolled if already drawing Social Security/RRB benefits; others must actively sign up
Initial Enrollment Period (IEP): 7‑month window—3 months before, the month of, and 3 months after the month you turn 65. Coverage start date varies by which month you enroll.
Cost
Part A (Hospital Insurance)
Premium‑free for most (≥40 quarters Medicare‑taxed work).
If not eligible: $285/mo (30–39 quarters) or $518/mo (<30).
Deductible $1,676 per benefit period;
daily hospital copays: $0 days 1‑60 after deductible, $419 days 61‑90, $838 lifetime reserve days 91‑150.
Part B (Medical Insurance)
Standard premium $185/mo in 2025; higher income pays more (IRMAA tiers begin above $106k single / $212k joint).
Annual deductible $257.
Late sign‑up penalty: +10% of premium for each full 12‑month period you were eligible but not enrolled (applies for life) unless you qualify for SEP.
Part D (Prescription Drug Coverage)
Plan premiums vary; No plan deductible may exceed $590 in 2025. Out‑of‑pocket spending on covered Part D drugs is capped at $2,000
Coverage
Part A: Inpatient hospital, skilled nursing facility (post‑qualifying stay), some home health, hospice; subject to benefit period deductible/coinsurance.
Part B: Physician/outpatient services, preventive services, durable medical equipment, some home health; generally 80% Medicare‑approved amount after deductible when provider accepts assignment; many preventive services $0.
Part C (Medicare Advantage): Private plan alternative bundling Part A & B and usually Part D; must cover all Medicare‑covered Part A/B benefits; often adds extras (dental, vision, hearing, fitness) subject to plan rules/networks.
Part D: Outpatient prescription drugs via stand‑alone PDPs or MA‑PDs; standardized stages (deductible → 25% coinsurance initial coverage → $0 after $2k OOP cap in 2025).
In Retirement
If you retire at/after 65 and had FEHB (or other employer group coverage) while working, you can enroll in Part B during the SEP and avoid the lifetime late penalty; have your employing office complete CMS‑L564 to document coverage.
Once retired, Medicare typically becomes primary and FEHB (or other retiree plan) becomes secondary; many FEHB plans waive or reduce their own cost‑sharing when Medicare is primary—worth reviewing plan brochure after retirement.
Consider enrolling in premium‑free Part A at retirement (unless delaying for HSA contributions while still working); evaluate Part B based on expected utilization.
Features
Guaranteed portability: Original Medicare accepted nationwide by providers who take Medicare; useful for retirees who move or travel
Robust preventive benefits: Many screenings/immunizations at $0 under Part B; adult ACIP‑recommended vaccines at $0 under Part D
Drug cost protections expanding: Insulin $35 cap; $2k annual Part D OOP ceiling in 2025; option to spread drug costs monthly via Medicare Prescription Payment Plan
Medicare + FEHB
While Still Working
FEHB is primary; you may defer Part B (and even Part A if preserving HSA eligibility), since FEHB pays first; enrolling in Part B while working usually offers limited added value because FEHB does not reimburse Part B premiums for active employees
f you instead enroll in a stand‑alone MA plan from Medicare (outside FEHB), you may choose to suspend (not cancel) FEHB to avoid dual premiums; suspension preserves your right to return to FEHB (typically during Open Season or qualifying event). Do not cancel FEHB in retirement unless you are certain—cancellation is generally irrevocable
We recommend that you take advantage of this great plan. Make sure that you have the right options in place in the event of your untimely death, to make sure that your survivors who need FEHB may continue.