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Should I stick with my Federal Employee Health Benefits or enroll in Medicare?

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Maureen – D.C.: I am a 72-year-old federal employee. I have been drawing Social Security since the age of 65. I am insured under Federal Employee Health Benefits. I have Medicare Part A. My question is whether I should stay with FEHB when I retire at, say, 76? I anticipate that you will advise me to inquire about the terms of both continued FEHB and Medicare enrollment at that time. But I have already inquired with my personnel office and my insurance company. Neither one has given me a helpful answer.

Phil Moeller: You win this week’s Ask Phil award for being a great planner. If we’re ever at a cocktail party together, we can stand in a corner talking about long-term tax planning while being shunned by everyone else! Unfortunately, your problems in getting a clear answer provide a real-world lesson in why planning is so essential to get your best deal from Medicare.

READ MORE: If I’m covered by the Affordable Care Act, do I have to switch to Medicare?

First, as you probably already know, you do not have to get Medicare when you retire and can keep your FEHB plan. Assuming your current FEHB insurer continues to be a “no show” in the customer-service arena, I would do some homework to figure out the package of Medicare policies that would provide you the best coverage at the least cost.

You could get a Medicare Advantage plan that includes a Part D drug plan. I know you’ve been unhappy with your insurer’s unresponsiveness, but please keep trying. You have time, and you really do need to find out how your FEHB plan would work with a Medicare Advantage policy.

Or you could get basic Medicare (Parts A and B), a stand-alone Part D drug plan and a “letter” plan Medigap policy that best meets your needs. You are not legally required to get a Medigap policy. And you may not need one.

As a Social Security recipient, you already have premium-free Part A of Medicare. This covers hospital care and will be the primary payer of such expenses, with your FEHB plan being secondary. If you get Part B of Medicare, which covers doctors, outpatient and medical equipment needs, it will be the primary payer here, but your FEHB will be secondary and thus may cover most of the holes in basic Medicare that are covered by Medigap.

The key question here is how your payments for continuing FEHB coverage compare with Medigap premiums. You can use Medicare’s online tool to get a rough idea of Medigap premiums where you live. And you should spend some time with Medicare’s Medigap manual to understand the 11 different “letter” Medigap plans you may be able to purchase and what they cover. Not all plans are offered in all markets.

READ MORE: Which Medigap plan should you get?

If you choose to drop your FEHB coverage and get a Medigap policy, you will trigger a six-month enrollment period during which you will be able to buy a Medigap policy on favorable terms. The phrase you’ll see in the manuals is “guaranteed issue rights,” which means you cannot be denied coverage due to pre-existing medical conditions or dinged on premiums because of your age. So if Medigap makes sense for you, make sure you get coverage when you have these rights.

You can find plenty of Medicare shopping tips in past Ask Phil columns. Once you know the cost of your Medicare solution, you at least can compare it with your current coverage and costs. Once you retire, you can see if the coverage and price of your FEHB policy changes as a retiree. I don’t think it should, but hey, there’s almost nothing about health insurance these days that doesn’t change. Good luck!

Deirdre – Calif.: I had and could resume having FEHB from my late husband. I chose a Medicare Advantage HMO (health maintenance organization) at 65, because it was less expensive and seemed to have comparable benefits. What I have been unable to find out from anyone is: If I also had any one (or a particular one) of the FEHB plans, would it cover whatever the Medicare Advantage plan does not? A related question applies to toric or multi-focal lenses for cataract surgery. I have been told that no insurance covers these. Is that true even if you had double insurance — FEHB and Medicare Advantage?

READ MORE: Should you stay on your employer health insurance or get Medicare?

Phil Moeller: According to an FEHB spokesman, the answer is “Yes, but. . . .” In other words, the FEHB plans do provide secondary coverage to what a Medicare Advantage plan does not cover or does not cover at 100 percent of the cost. But not all FEHB plans are the same, so you need to do your homework and find out exactly how specific plans work with Medicare Advantage and whether the added protection is worth the extra cost of paying for both types of insurance. As for the lenses needed after cataract surgery, you’re probably out of luck, the spokesman said. If neither policy covers them, it won’t make a difference if you have both policies or not.

Adriana – Texas: My father is currently on Medicare and receives Social Security disability payments. He and my mother would like to remarry. My mother is my dependent, and she has no income. Will their marriage affect his benefits?

READ MORE: What happens to your Social Security benefit when you marry?

Phil Moeller: I think it’s sweet they want to get back together. And in this case, romance should not cost him! If your mother has no taxable income, then your father’s taxable income should not change following his remarriage. I can really see no other possible adverse impact on either his Medicare or Social Security. To be safe, before acting on this answer, you should check with a Medicare counselor at the State Health Insurance Assistance Program (SHIP). Good luck!

Amanda – Mich.: I am a traveling nurse. My husband is on Social Security disability and has Medicare. Do we need to notify Medicare that he will be out of Michigan for any length of time to have his medical needs covered? We may be out of state from four months to a year.

READ MORE: On the road? Medicare options for travelers in the U.S.

Phil Moeller: If he has basic Medicare (Parts A and B, a Part D drug plan and perhaps a Medigap policy), he can see health care providers anywhere in the country who accept Medicare (and nearly all do) and still be covered. If, however, he has a Medicare Advantage plan, he might not be covered if he uses health services outside of the plan’s provider network. Most networks are limited to a local or regional geographic market. If this is the case, you should check with his Medicare Advantage insurer to find out details on how out-of-network care would be covered if at all.

Beth – Ark.: My husband is 65 and has already signed up for Medicare Part A but not Part B. He is covered by his employer at this time. He is going to retire in 2016, and I am going back to work full-time for a large company that will allow me to cover my husband on my health insurance plan. It is a high-deductible plan, and the company sets up a health savings account and puts in money for both of us to start, and then I can also fund it through my paycheck. Will my husband be penalized for not signing up for Medicare B since he is going from his plan to mine, and does it matter that mine is a high-deductible plan and that the company and I fund the health savings account?

READ MORE: Why health savings accounts and Medicare don’t mix

Phil Moeller: Your husband can be covered on your plan and will not face a penalty. Just make sure he is covered under your new employer’s plan before his existing employer coverage ends. If not, he should get COBRA, even if only for a month. There is no reason to go without coverage and gamble that he doesn’t have a major health issue. Also, if he is taking Social Security benefits, you will not be able to make tax-exempt contributions in his name into your health saving account plan. You can still participate in the plan, and his qualifying health expenses can still be paid for out of your health saving account. But you can’t make spousal contributions into the plan. IRS Publication 969 has more details on HSA rules.