FEHB 101: What is the Federal Employees Health Benefits program?
The Federal Employees Health Benefits (FEHB) program is the largest employer-sponsored group health insurance program in the world, covering over 8 million Federal employees, retirees, former employees, family members, and former spouses. It is designed to help you and your family meet your health care needs with the widest selection of health plans in the country. There are special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.
Types of FEHB
There are three types of enrollments:
- Self Only
- Self Plus One enrollment covers you and one eligible family member
- Self and Family enrollment covers you, your spouse, and your children under age 26
Each health plan carrier under the FEHB Program charges a different premium. The Government pays up to 75% of the cost of your health benefits coverage, and you pay the remainder, based on a formula set by law.
Over 200 health plan choices are offered under the FEHB Program. Of the available fee-for-service plans, several are open to all enrollees, while others are available only to specific categories of employees. In addition, health maintenance organizations (HMOs) are available in most areas of the United States.
Each year, during Open Season, enrollees are able to change health plans and/or the type of enrollment they have. Eligible employees may also enroll during this time. Open Season runs from the Monday of the second full work-week in November through the Monday of the second full workweek in December. There are limited opportunities to enroll, cancel your enrollment, or change your enrollment outside of an Open Season.
The Federal Dental and Vision Insurance Plan (FEDVIP) is also related to FEHB. If you or your family member has significant dental or vision expenses to cover, enrolling in FEDVIP is usually a good idea.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and/or people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). It is the second largest social insurance program in the country, behind Social Security.
Medicare is divided into four parts, covering specific services.
- Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Part C is more like traditional health insurance. For federal employees and retirees who stay enrolled in FEHB, Part C is not needed.
- Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines).
Once you enroll, you’ll need to decide how you’ll get your Medicare coverage.
With Original Medicare, you pay for services as you get them. When you get services, you’ll pay a deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D). Part A & Part B pay for much, but not all, of the cost for covered health care services and supplies. Adding a Medicare Supplement Insurance (Medigap) policy can help eliminate some of the remaining health care costs, like copayments, coinsurance, and deductibles.
Medicare Advantage is an all-in-one alternative to Original Medicare. These bundled plans include Part A, Part B, and usually Part D. Most plans offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more. Medicare Advantage Plans have yearly contracts with Medicare and must follow Medicare’s coverage rules. The plan must notify you about any changes before the start of the next enrollment year.