Federal Benefits Question of the Week: Medicare and FEHB

Q: I recently retired and have enrolled in Medicare Parts A and B along with maintaining my FEHB coverage. Which coverage will pay first for my health care expenses?

A: Once you have retired and are enrolled in Medicare Part A (hospital insurance) and Part B (doctors or outpatient insurance), Medicare will be the primary payer for both inpatient and outpatient services. The insurance that pays first (primary payer) pays up to the limits of its coverage. The one that pays second (secondary payer) only pays if there are costs the first payer didn’t cover. The secondary payer (which could be Medicare) might not pay all the uncovered costs. You can find more information about who pays first at www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance.

It is important that you communicate your retirement and Medicare coverage to the following places to be sure that there is no confusion when your bills for medical services are being coordinated:

1. Your medical providers need to know that they should now bill Medicare first and the claim will be coordinated with your secondary payer through Medicare. Let your providers know when you have retired and are covered by Medicare and any other health insurance, including FEHB, military health care or another employer health plan.
2. Call the Medicare Benefits Coordination and Recovery Center (BCRC) to update your insurance coordination of benefits information. BCRC customer service representatives are available to assist you Monday through Friday, from 8 a.m. to 8 p.m. ET, except holidays, at toll-free lines: 1-855-798-2627 (TTY/TDD: 1-855-797-2627 for the hearing and speech impaired).
3. You must tell your FEHB plan if you or a covered family member has Medicare coverage, and let your plan obtain information about services denied or paid under Medicare if it asks. You must also tell your FEHB plan about other coverage you or your covered family members may have, as this coverage may affect the primary/secondary status of your FEHB plan and Medicare.