Turning age 65 is a milestone for everyone. For federal employees, it’s also the time when federal law requires you to make a decision about enrolling in Medicare. Before you make any changes, it’s important to understand what traditional Medicare Part B (outpatient services) does not cover.
Medicare Part B Doesn’t Cover Outpatient Prescription Drugs
Outpatient prescriptions are not covered by traditional Medicare Part B. To get a prescription plan through Medicare, you would have to purchase Part D. Since most federal employees have prescription drug coverage through their FEHB plan, Medicare Part D doesn’t offer an advantage. In fact, the OPM has determined that FEHB prescription plans are not only comparable to Medicare Part D they also have fewer restrictions.
Medicare Part B Doesn’t Cover Routine Vision & Dental Care Or Hearing Aids
One of the biggest complaints about traditional Medicare is the lack of coverage for vision and dental care, eyeglasses and hearing aids. Before making any changes to your coverage, it’s important to find out if your FEHB plan covers any of these costs. Check Section 9 in your FEHB plan brochure to confirm if these services are covered and how much is allowed.
“While both FEHB and Medicare cover approved medical needs when you’re in long-term care, the cost of non-medical, custodial care is not covered.”
Medicare Part B Doesn’t Cover Non-Medical Long-Term Care (LTC)
Non-Medical long-term care is assistance with day-to-day activities you’re unable to perform on your own: dressing, bathing, eating and other basic activities. While both FEHB and Medicare cover approved medical needs when you’re in long-term care, the cost of non-medical, custodial care is not covered. If you haven’t purchased LTC insurance, the out-of-pocket costs for a room in a nursing room can run as high as $10,000 per month depending on where you live.
The Big Drawback: Medicare Part B Premiums
Medicare Part B Premiums tend to increase from year to year. For 2024, the standard monthly premium for Part B is $174.70 and the annual deductible is $240. Add to this, if your income exceeds yearly threshold tiers set by Social Security, you’ll have to pay a surcharge in addition to your Part B Premium.
Coordinating Medicare & FEHB In Retirement
Generally, if you’re enrolled in one of FEHB’s HMO plans you may not need traditional Medicare Part B because HMOs cover most of the same services. Then again, you may want to consider coordinating FEHB with Medicare because Part B pays for visits to doctors outside your HMO network. To learn more, read our article: Understanding The Coordination Of FEHB & Medicare Coverage. Also check out the FEHB and Medicare Fact Sheet on the OPM website.
Source: www.Medicare.gov
