The Federal Employees Health Benefits (FEHB) program is an insurance plan for federal employees that works alongside Medicare. Active or retired federal employees may be eligible to receive coverage from both.
Medicare is a federally funded insurance plan for people ages 65 years and older. Younger people with disabilities may also be eligible.
If a person is or has been a federal employee, a selection of medical insurance plans may be available through the FEHB program.
Read on to learn more about the FEHB program, how it works with Medicare, and who can enroll.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
FEHB insurance covers active federal employees, their family members, some former spouses, and former employees.
Unlike other private insurance plans, there are no waiting periods for coverage to become active.
There are also no preexisting condition limits. This means that if a person with a health condition enrolls, the plan covers health costs up to the plan limits.
People with FEHB coverage can choose from different types of healthcare plans. Plans can include:
- Health Maintenance Organizations (HMO): HMO plans are available in geographical and service areas that have specific healthcare provider agreements to control costs. Some HMO plans include a Point of Service (POS) product, which means that a person can use out-of-network services but at a higher cost.
- Preferred Provider Organizations (PPO): With a PPO plan, a person usually pays fewer out-of-pocket expenses.
- Fee-for-Service (FFS): With FFS plans, healthcare providers agree to lower prices, making them in network. FFS plans can be either with or without PPO.
- Consumer-Driven Health Plans (CDHP): Up to a certain amount, a person will receive full coverage for in-network preventive care. After this amount, cost sharing is usually significantly higher.
- High Deductible Health Plan (HDHP): In 2025, HDHPs have a deductible of at least $1,650 for an individual or at least $3,300 for a family. Annual out-of-pocket costs will not exceed $8,300 for an individual and $16,600 for a family.
Learn about HMO and PPO Medicare plans.
Medicare and the FEHB program may cover any active or retired federal employees. The two programs work together to provide healthcare coverage.
To be eligible for Medicare, a person typically must be 65 years old or over. Younger people with specific conditions, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), may also qualify for coverage under Medicare.
The Office of Personnel Management (OPM) recommends that people with FEHB insurance consider Medicare Part A if they are eligible for premium-free coverage.
People who have worked for 10 years and paid Medicare taxes will generally be eligible for premium-free Medicare Part A. Enrolling in Part A may help cover deductibles, coinsurance, and other costs beyond those that FEHB allows.
Learn more about parts of Medicare that may be free.
Retirement
A person can continue benefits with FEHB after retirement. To do so, they must retire on an immediate annuity and have been continuously enrolled in any FEHB program for 5 years before retirement.
New employees can enroll in the FEHB program and its dental and vision policies within 60 days of their employment start date, also known as entry on duty.
Open season
If an employee does not enroll within 60 days, they will have to wait until open season, which runs between the second Monday in November and the second Monday in December each year.
Some circumstances allow a person to make changes outside of open season. In these cases, they must make changes within 60 days of a major qualifying life event. These events can include:
- marriage
- legal separation
- divorce
- death of a dependent or spouse
- birth or adoption of a child
- taking in a foster child
- change in employment status
- loss of FEHB or other health coverage
For most people, the employer shares the costs of FEHB with the federal government.
The government pays 72% of the premiums for:
- employees (self only)
- self plus one
- self and family
However, some people with FEHB coverage do not receive a contribution toward the premium from the government. These include:
- temporary employees
- a past spouse enrolled under spouse equity provisions
- a person or dependent covered under temporary continuation of coverage
View the table below for the maximum government contributions for most employees in 2025.
| Biweekly premium | Monthly premium | |
|---|---|---|
| Self only | $298.08 | $645.84 |
| Self plus one | $650.00 | $1,408.33 |
| Self and family | $714.23 | $1,547.50 |
An active federal employee is on a primary payer plan, meaning that any medical claims will first go to FEHB plans for payment consideration.
If a person works past age 65 years, FEHB continues to be the primary payer until the employee’s retirement.
The primary payer also defaults to FEHB when the employee or a covered member has ESRD. In this case, they pay first in the first 30 months of eligibility.
FEHB is the primary payer when a person is:
- under the age of 65
- eligible for Medicare based on a disability
- covered under FEHB based on the person or person’s spouse’s employment
Medicare will become the primary payer after a person has retired or if a person no longer employed by the government is getting workers’ compensation.
A person may be retired, with Medicare, and covered by a spouse’s policy. In this case, the spouse’s policy is the primary payer. Medicare is the second payer, and FEHB pays after that.
Learn more about Medicare as a secondary payer.
Does a person need both FEHB and Medicare?
Having both FEHB and Medicare can provide an individual with additional benefits. The OPM recommends enrolling in Medicare Part A if a person is eligible for premium-free coverage. However, if a person has Medicare Advantage, then they may not need FEHB as well, as the plans may provide a lot of the same benefits.
What happens to my FEHB when I turn 65 years old?
FEHB coverage will continue once a person turns 65 years old. If a person enrolls in Medicare, they can still keep their FEHB plan.
Can you suspend FEHB for Medicare Advantage?
A person can suspend their FEHB coverage and enroll in Medicare Advantage instead. Before suspending or canceling FEHB, a person should make sure that the Medicare Advantage plan provides them with the coverage they need.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Federal Employees Health Benefits (FEHB) is an insurance plan for federal employees. A person can have both FEHB insurance and Medicare.
When a person is employed, the FEHB policy is the primary payer. Medicare becomes the primary payer after a person retires and enrolls in a Medicare plan.
Enrollment must take place within 60 days of an employee’s start date. Open season allows individuals a second opportunity to enroll in or amend their coverage. This period occurs every year between November and December.
The government can pay up to 72% of the employees’ FEHB premiums. A person will continue to pay the premium after retirement.
