As a rule, at retirement you may keep your Federal Employees Health Benefits program coverage if you are currently enrolled and have been enrolled in the FEHB for at least five years or from your earliest opportunity to enroll. It makes no difference if you’ve bounced around from plan to plan. What matters is that you have been continuously enrolled in some FEHB plan for a full five years before you retire.
If you can’t meet that requirement, you’re out of luck unless you qualify for a waiver. OPM is able to grant pre-approved waivers if you are offered and accept an early retirement offer. Of course there are certain conditions that you must meet; these differ slightly for DoD and non-DoD employees. If an early out offer comes your way, your agency will let you know if you qualify for a pre-approved waiver.
If you don’t meet the requirements, you can ask OPM for an individual waiver. But don’t get your hopes up. OPM can only grant you a waiver if it would be against equity and good conscience not to do so. That’s a high bar to get over, and few make it.
If you don’t meet the requirements and don’t get a waiver, you’ll be given a 31-day extension of coverage at no cost to you. Then, if you want to, you can either convert to an individual contract or ask for temporary continuation of coverage. Under TCC, you can keep your FEHB enrollment for up to 18 months. However, you’ll be required to pay the full premium plus 2 percent to cover administrative costs.
If you are able to carry your FEHB coverage into retirement, you’ll pay the same premiums you did as an employee, only on a monthly basis rather than biweekly. However, bear in mind that while employees can pay premiums on a pre-tax basis through “premium conversion”—and almost all of them do—that is not available to retirees. So, effectively FEHB costs more in retirement.
You’ll also be eligible to make the same kinds of changes allowed to active employees during the annual open season or when certain life events occur, with one big exception: you cannot get back into the program if you cancel your coverage.
When you approach age 65 and will eligible for Medicare, you’ll have decisions to make.
First, will you need the same level of FEHB coverage? The answer to that question isn’t an easy one because it depends on such things as the cost and benefits of the plan you will be in at that time and the extent to which it overlaps with Medicare Part A. You’ll have to do the research.
Second, should you enroll in Medicare Part B (medical insurance)? If you are enrolled in a fee-for-service plan, such as Blue Cross-Blue Shield, you may want to seriously consider enrolling in Part B. That way, nearly all of your medical expenses will be covered. If you are enrolled in an HMO, it also might be a good idea.
There are two reasons for this. One, if you expect to use non-plan providers, Medicare Part B will help cover those costs. Two, if you later move to a fee-for-service plan, and want to enroll in Part B, your premiums will be up to 10 percent higher for each 12 months that you could have been under that coverage but weren’t.