Your Final Decision on Medicare Part B and the FEHB Program

Throughout our advice we have highlighted specific advantages and disadvantages of enrolling in Medicare Part B in addition to your FEHB enrollment. On the minus side there is one large factor—paying two costly sets of premiums instead of one. For those who pay the higher part B “income-tested” premiums, this is a very considerable cost, between about $2,400 and for some almost $6,000 extra to join Part B, depending on exact income level. On the plus side there are several factors, including avoiding network restrictions, better coverage for a few services, and having the option to join Medicare Advantage plans and paying only one premium without losing FEHB eligibility.

By now, you should realize that you have many options, each with advantages and disadvantages. Taking into account dollar costs only, there are five good sets of options.

  • One option is to enroll in a Medicare Advantage plan and suspend FEHB enrollment. This is the lowest-cost option for many. Many MA plans have benefits as good as many FEHB plans and charge nothing beyond the regular Part B premium.
  • A second option is to enroll in a plan that contributes a substantial amount toward your Medicare premium, such as Aetna Direct CDHP or Blue Cross Basic. In both CDHP and HDHP plans your special account will pay towards the Part B premium (or in the Aetna Direct plan for drug or dental costs not otherwise covered), and you also get a Medicare wraparound. Several HDHP plans give you an equivalent value through their Health Reimbursement Account. We rate MHBP HDHP and CareFirst HDHP as particularly good buys.
  • A third option is to enroll simultaneously in a UnitedHealthcare or Kaiser FEHB plan and the corresponding local Medicare Advantage plan to obtain a “Senior Advantage” or “Retiree Advantage” option that pays most of the Part B premium while dramatically lowering your cost-sharing for medical expenses.
  • A fourth cost-saving choice is to enroll in an FEHB plan with good benefits such as APWU, NALC, Kaiser Standard option, or a number of HMO, HDHP, and CDHP plans, and bypass Medicare Part B enrollment.
  • As a fifth choice, you can enroll in a relatively low-premium plan like FEP Blue Focus, Aetna Advantage, Blue Cross Basic, CareFirst Blue Value, Aetna Direct or MHBP HDHP, along with Part B, and get either a rich Medicare wraparound benefit or simply the ability to use Medicare to go outside the plan’s network should you choose to do so.

All of these options and the plans that save the most money within each option vary in detail that you can only assess after studying the brochure of several plans. All of them can provide most annuitants substantial annual savings.

What you should generally not do is stay in a high premium FEHB plan to get the Part B wraparound benefit when you can join a less costly FEHB plan with an equally good wraparound benefit. If your medical costs are close to zero in a number of plans, in or out of network, why pay a higher rather in lower premium? Of course, there are always cases where even the most expensive combination provides a benefit essential to you. And differences in prescription drug formularies or cost sharing can make a seemingly more expensive option actually a less expensive option. So, there is no simple “one size fits all” answer. What you should do, regardless, is at least be aware of the dollar costs or gains of whatever decision you reach.

We show the extra cost of enrolling in both an FEHB plan and Medicare Part B and show which plans are likely to cost you the least or save you the most by enrolling in Part B. We present the plans in national and local groups, and within each list the plans in order of the lowest cost for self only enrollment in both FEHB and Part B. Some plans cost very little extra for Part B, taking into account both premium and enhanced benefits. These are sometimes the plans that offer the best premium reimbursements, and sometimes not. The comparisons do not include estimates for the options involving enrollment in Medicare Advantage as your primary plan, but these are generally better buys than those shown, provided that you are willing to consider such a major change.