Understanding FEHB Plans for Retirees: Comprehensive Guide to Federal Employee Health Benefits After Retirement

For many retirees, the ability to continue participating in the FEHB Program is a significant advantage compared to other sectors, where employer-sponsored health coverage may end at retirement. FEHB offers access to a broad selection of health plans, including fee-for-service, health maintenance organizations, and high-deductible options, each with varying premiums, coverage levels, and provider networks. The program is regulated and overseen by the U.S. Office of Personnel Management (OPM), which ensures that plans remain competitive and responsive to the needs of both active employees and retirees.

Making the right decision about FEHB coverage at retirement can have lasting financial and personal implications. Retirees must consider factors such as plan premiums, out-of-pocket costs, prescription coverage, coordination with Medicare, and eligibility requirements. This guide aims to demystify the FEHB landscape for retirees, providing clear information on available plans, enrollment processes, and strategies for maximizing benefits while minimizing costs. Whether you are nearing retirement or already enjoying your post-career years, a thorough understanding of FEHB plans can help you make informed choices about your health and financial well-being.

Federal retirees have a unique advantage when it comes to health coverage, thanks to the Federal Employees Health Benefits Program. Unlike many private-sector employees who may lose access to group health insurance upon retirement, federal retirees can continue their FEHB coverage for life, provided they meet certain eligibility requirements. This continuity offers peace of mind and stability, especially as health care needs often increase with age. Understanding the nuances of FEHB plans, how they interact with other benefits such as Medicare, and the options available each Open Season is crucial for making the most of this valuable benefit. The following sections break down the essentials of FEHB for retirees, including plan types, costs, enrollment guidelines, and tips for selecting the right coverage.

Overview of FEHB Plans for Retirees

The FEHB Program is one of the largest employer-sponsored health insurance programs in the United States. It provides a variety of health plan options to federal employees, retirees, and their eligible family members. Upon retirement, federal employees who meet the eligibility criteria can continue their FEHB coverage, often with the same government contribution toward premiums as when they were working.

• Wide selection of plans: Fee-for-Service (FFS), Health Maintenance Organizations (HMOs), Consumer-Driven and High Deductible Health Plans (HDHPs).
• Nationwide and regional options: Some plans offer national coverage, while others are specific to certain regions or states.
• Continued government contribution: The federal government typically pays up to 72 percent of the weighted average premium, making coverage more affordable.
• Guaranteed coverage: No medical underwriting or exclusions for pre-existing conditions.

Eligibility Requirements for Retirees

To maintain FEHB coverage into retirement, federal employees must generally meet the following criteria:

• Be entitled to retire on an immediate annuity (not a deferred annuity).
• Have been continuously enrolled (or covered as a family member) in any FEHB plan for the five years of service immediately before retirement, or for the full period of service if less than five years.
• Elect to continue FEHB coverage at retirement.

Survivors of retirees may also be eligible to continue FEHB coverage under certain conditions.

Types of FEHB Plans Available

Retirees can choose from a variety of FEHB plan types, each offering different features, provider networks, and cost structures:

• Fee-for-Service (FFS) Plans: These plans offer flexibility in choosing providers and are often available nationwide. Examples include Blue Cross and Blue Shield Service Benefit Plan and GEHA Standard Option.
• Health Maintenance Organizations (HMOs): HMOs typically require members to use a network of providers and may require referrals for specialist visits. These plans are often regional. Examples include Kaiser Permanente and Aetna Direct.
• Consumer-Driven and High Deductible Health Plans (HDHPs): These plans usually feature lower premiums, higher deductibles, and the option to use a health savings account (HSA) or health reimbursement arrangement (HRA). Examples include Aetna HealthFund HDHP and Mail Handlers HDHP.

FEHB and Medicare Coordination

Many federal retirees become eligible for Medicare at age 65. Understanding how FEHB and Medicare work together is essential for optimizing coverage and minimizing costs:

• Retirees can keep FEHB coverage even after enrolling in Medicare.
• Medicare typically becomes the primary payer, while FEHB serves as secondary coverage, covering costs not paid by Medicare.
• Some FEHB plans waive certain out-of-pocket costs for retirees enrolled in both FEHB and Medicare Part A and Part B.
• Retirees may choose to suspend (but not cancel) FEHB coverage if enrolling in a Medicare Advantage plan, allowing them to return to FEHB during a future Open Season.

Costs and Premiums for Retirees

FEHB premiums for retirees are generally the same as those for active employees, except retirees pay premiums on an after-tax basis. The government continues to contribute a significant portion of the premium. Out-of-pocket costs, such as deductibles, copayments, and coinsurance, vary by plan and should be carefully compared when selecting coverage.

Comparison Table: Popular FEHB Plans for Retirees (2025)

Enrollment and Open Season Considerations

Retirees can change FEHB plans each year during the annual Open Season, typically held from November to December. Changes can also be made after certain qualifying life events, such as marriage or loss of other coverage. It is important to review plan brochures, compare costs and benefits, and consider anticipated health care needs before making a selection.

• Review plan brochures for coverage details and provider networks.
• Use the OPM Plan Comparison Tool to evaluate options.
• Consider how plans coordinate with Medicare and other coverage.

Tips for Choosing the Right FEHB Plan as a Retiree

• Assess your health care needs and anticipated usage.
• Compare premiums, deductibles, and out-of-pocket maximums.
• Check provider networks to ensure your preferred doctors and hospitals are included.
• Evaluate prescription coverage and costs.
• Consider the impact of enrolling in Medicare Parts A and B.
• Look for plans that waive or reduce cost-sharing for Medicare enrollees.

Frequently Asked Questions

• Can I keep my FEHB coverage for life? Yes, as long as you meet the eligibility requirements at retirement and continue to pay premiums.
• Do my family members remain covered? Eligible family members can remain covered as long as you maintain a family enrollment.
• Can I suspend FEHB coverage? Retirees can suspend (not cancel) FEHB coverage to enroll in a Medicare Advantage plan or TRICARE, with the option to return to FEHB during Open Season.
• What happens if I move to another state? Many FEHB plans offer nationwide coverage, but it is important to check provider networks and plan availability in your new location.

Additional Resources and References

• U.S. Office of Personnel Management (OPM) - https://www.opm.gov
• Federal Employees Health Benefits (FEHB) Program - https://www.opm.gov/healthcare-insurance/healthcare/
• National Active and Retired Federal Employees Association (NARFE) - https://www.narfe.org