Using Your Benefits
Get the most out of your Blue Cross and Blue Shield Federal Employee Program (FEP) coverage with Medicare.
Here’s how your coverage works
When you’re an active federal employee, FEP is typically your primary coverage, which means we pay for your health care services first.
When you retire and have Medicare, it typically becomes your primary coverage and it pays first.
If you decide to combine Medicare and your FEP coverage, we’ll pay for covered services not covered by Medicare. When Medicare is primary, your doctor will send claims to Medicare first. Then Medicare will send the claims to us.
Finding a provider
Medicare has its own network of Participating providers. These are providers who accept Medicare’s assignment or payment. If you combine FEP and Medicare, you can go to any provider within the FEP network even if they are not in Medicare’s network.
You can see which providers are in Medicare’s network at medicare.gov/care-compare.
Costs for visiting a provider when you have Medicare
Participating providers
A participating provider accepts Medicare's assignment. When you visit a Participating provider, FEP will pay the difference between what Medicare pays and what you owe the provider for services that both Medicare and FEP covers. Which means you’ll pay nothing for these services.
Non-participating providers
Non-participating providers accept Medicare patients but can choose to accept Medicare’s assignment. There is a limit to the amount of money a provider can charge if they do not accept Medicare’s assignment. This is called the limiting charge. The limiting charge is 15% over Medicare’s approved amount. You’ll pay the difference between our payment combined with Medicare’s payment and the limiting charge or the provider’s charge, whichever is less.
Opt-out providers
Opt-out providers agree to opt-out of the Medicare program altogether. A provider who has opted out of Medicare is not limited to the limiting charge. We recommend asking your provider if they have opted out of Medicare.
These providers may ask you to sign a contract. This contract will ask you to agree to the provider billing you directly for services. We do not recommend signing a contract like this. If you do, Medicare will not cover your service and FEP will only pay the amount we would have paid if Medicare paid their portion. You will have to pay all additional charges.
FEP Medicare Prescription Drug Program (MPDP)
Eligible members with Medicare get lower out-of-pocket costs for higher cost drugs and additional approved prescription drugs in some tiers than the traditional pharmacy benefit.
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Get up to $800 back with a Medicare Reimbursement Account
FEP Blue Basic™ members who have Medicare Part A and Part B can get reimbursed up to $800 a year for paying their Medicare Part B premiums.
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