{"id":21768,"date":"2025-10-14T14:42:02","date_gmt":"2025-10-14T14:42:02","guid":{"rendered":"https:\/\/finderica.com\/?p=21768"},"modified":"2025-10-14T14:42:02","modified_gmt":"2025-10-14T14:42:02","slug":"how-federal-employees-qualify-for-medicare","status":"publish","type":"post","link":"https:\/\/finderica.com\/?p=21768","title":{"rendered":"How Federal Employees Qualify For Medicare"},"content":{"rendered":"
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Federal employees who retire when they are in their late 50\u2019s or early 60\u2019s can look forward to hopefully as many as 25 to 30 years of retirement. Medical innovations such as state-of-the art surgical procedures, improved medicines and insurance plans that facilitate access to the newest treatments have contributed to longevity.<\/p>\n

With respect to health insurance coverage during their retirement, federal employees who are enrolled in the Federal Employees Health Benefits (FEHB) program who meet the requirements are eligible to keep their FEHB health insurance when they retire from federal service. The FEHB program provides high quality health insurance for employees and retirees. Employees and retirees pay on average 25 to 28 percent of the FEHB premium no matter which FEHB health insurance plan they are enrolled in, and no matter what type of health insurance coverage they have. This includes: (1) Self only; (2) Self plus one eligible family member; or (3) Self and family coverage.<\/p>\n

SEE ALSO:<\/strong><\/em> <\/span>10 Common Medicare Mistakes Federal Retirees Should Avoid<\/span><\/p>\n

Once a federal employee or retiree becomes age 65, the employee or retiree is encouraged (but not required) to enroll in Medicare. Many federal employees and retirees have questions about Medicare enrollment including:<\/p>\n

(1) What is Medicare and what are the various parts to the Medicare program?;
(2) When and how does a federal employee enroll in Medicare?; and
(3) Why should a federal employee enroll in Medicare when they are enrolled in an FEHB plan?<\/p>\n

A series of columns will answer these questions.\u00a0\u00a0This column discusses what is Medicare, the various parts to the Medicare program, and how federal employees qualify for Medicare.<\/p>\n

What Is Medicare?<\/h2>\n

Medicare is a federal government-sponsored group health insurance program for individuals aged 65 and older. Younger individuals receiving Social Security disability benefits for a minimum two years are also eligible to enroll in Medicare. The program helps with the cost of health care, but it does not cover all medical expenses or most long-term care expenses. Medicare pays medical bills from trust funds which those covered by Medicare have paid into via the Medicare Part A payroll. This includes all workers including self-employed individuals.<\/p>\n

What Are the Parts to Medicare?<\/h2>\n

There are four parts to Medicare:<\/strong><\/p>\n

1. Medicare Part A (Hospital Insurance).<\/strong> Medicare Part A helps pay inpatient care in a hospital or limited time at a skilled nursing facility following a hospital stay. Part A also pays for some home health care and hospice care.<\/p>\n

2. Medicare Part B (Medical Insurance).<\/strong> Medicare Part B helps for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventative services. SEE ALSO:<\/strong><\/em> Why Some Federal Retirees Pay More for Medicare Part B<\/p>\n

3. Medicare Advantage, previously known as Medicare Part C (Medicare Choice plans).<\/strong> Medicare Advantage includes all benefits and services covered under Medicare Part A and Medicare Part B, plus prescription drugs and additional benefits such as vision, hearing and dental \u2013 all bundled together in one plan.<\/p>\n

4. Medicare Part D (Medicare prescription drug coverage).<\/strong> Medicare Part D helps cover the cost of prescription drugs. Part D plans must cover at least two drugs in each of six therapeutic categories, anti-depressants, antipsychotics, anticonvulsants, immunosuppressants and antineoplastics.<\/p>\n

Medicare supplemental (Medigap) policies help Medicare out-of-pocket copayments, coinsurance and deductible expenses and are run by private insurance companies that follow rules set by Medicare.<\/p>\n

How Do Federal Employees Qualify for Medicare Enrollment?<\/h2>\n

SEE ALSO:<\/strong><\/em><\/span> Should Federal Retirees Enroll in Medicare?<\/span><\/p>\n

All private sector and government employees (federal, state and local) including federal employees pay (via payroll deduction) the Medicare Part A Hospital Insurance Tax (HIT). The HIT is equal to 1.45 percent of an employee\u2019s gross wages, no matter the amount of an employee\u2019s wages. An employee pays the HIT and the employer also pays the HIT on behalf of the employee. The total HIT is therefore 2.9 percent.<\/p>\n

If an employee has paid the HIT for a minimum of 10 years during the employee\u2019s employment lifetime, the employee is considered \u201cfully insured\u201d for Medicare purposes. This allows the individual to enroll in Medicare Part A at age 65. In addition:<\/p>\n

\u2022 As a result of an individual\u2019s paying the Medicare HIT for a minimum of 10 years, the individual pays no monthly premium when he or she is enrolled in Medicare Part A.<\/p>\n

\u2022 If eligible to enroll in Medicare Part A, an individual is automatically eligible to enroll in Medicare Part B (medical insurance), Medicare Part C (Medicare Advantage) and Medicare Part D (prescription drug coverage).<\/p>\n

\u2022 Federal retirees who are eligible to keep their FEHB program health insurance during their retirement are encouraged (but are not required by the Office of Personnel Management) to enroll in Medicare. They are highly encouraged to enroll in \u201cOriginal Medicare\u201d (Medicare Parts A and B) in order to minimize, most likely eliminate, any out-of-pocket doctor and hospital bills. This assumes that a federal retiree\u2019s doctors and hospitals accept Medicare patients, and most do.<\/p>\n

To fully understand how enrollment in Original Medicare will minimize a federal retiree\u2019s out-of-pocket doctor and hospital expenses, it is important to present the following information:<\/strong><\/p>\n

\u2022 For federal retirees who have enrolled in Original Medicare, Medicare is considered the retiree\u2019s primary payor and their FEHB health plan is considered secondary coverage.<\/p>\n

\u2022 Original Medicare pays on average 60 to 80 percent of a doctor\u2019s or a hospital\u2019s expenses incurred by a Medicare-enrolled patient. A doctor or hospital who accepts \u201cMedicare assignment\u201d will then bill the Medicare-enrolled patient\u2019s Medicare supplemental health insurance. The supplemental health insurance will pay some or all of the remaining 20 to 40 percent expense incurred by the patient. If any expenses remain, the doctor or hospital cannot bill the patient. Doctors and hospitals are not permitted to perform \u201cbalance billing.\u201d \u201cBalance billing\u201d occurs when a patient is billed by a doctor or a hospital for the difference between the doctor or hospital total charges and whatever Medicare and the Medicare supplemental health insurance plan pay. The result is that the Medicare-enrolled patient pays nothing (this includes paying no deductible, no co-insurance and no co-payments).<\/p>\n

\u2022 A federal retiree need not purchase a Medicare supplemental or Medigap plan. His or her FEHB health plan is considered a Medicare supplemental health insurance. Federal retirees are reminded that retirees pay the same percentage of FEHB health plan premiums (25 to 28 percent) as employees do. The difference is that federal employees normally have out-of-pocket expenses such as deductibles, co-payment and coinsurance that a federal annuitant enrolled in Original Medicare does not have.<\/p>\n

The next column will present the various Medicare enrollment periods for federal retirees.<\/p>\n

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Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Federal employees who retire when they are in their late 50\u2019s or early 60\u2019s can look forward to hopefully as many as 25 to 30 years of retirement. Medical innovations such as state-of-the art surgical procedures, improved medicines and insurance plans that facilitate access to the newest treatments have contributed to longevity. With respect to<\/p>\n","protected":false},"author":2,"featured_media":6015,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"footnotes":""},"categories":[348],"tags":[2524,478,357,361],"class_list":{"0":"post-21768","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-retirement","8":"tag-employees","9":"tag-federal","10":"tag-medicare","11":"tag-qualify"},"_links":{"self":[{"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/posts\/21768","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21768"}],"version-history":[{"count":0,"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/posts\/21768\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/media\/6015"}],"wp:attachment":[{"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21768"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21768"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21768"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}