Federal retirees who are enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can choose the type of Medicare coverage that best meets their needs. The choices are: (1) stay in Original Medicare (Medicare Part A and Medicare Part B) together with a health plan from the Federal Employees Health Benefits (FEHB) program, which acts as a Medicare supplement plan and pays for most health care expenses that Original Medicare does not pay in full; or (2) enroll in a Medicare Advantage plan.
Federal retirees enrolled in Original Medicare have two ways to enroll in a Medicare Advantage plan:
- A private Medicare Advantage plan. The retiree suspends FEHB program enrollment and enrolls in the private plan during the current Medicare open enrollment period (OEP), October 15 through December 7.
- A Medicare Advantage plan offered through the FEHB program during the upcoming FEHB open season, November 9 through December 14, 2026. Several FEHB program insurance companies offer Medicare Advantage plans to federal retirees who are enrolled in Original Medicare.
This column explains the differences between Original Medicare and Medicare Advantage. For more on how the open enrollment period affects federal retirees, see Medicare Open Enrollment 2026: How It Affects Federal Retirees in FEHB.
How Original Medicare Works With an FEHB Plan
Federal retirees enrolled in Original Medicare and an FEHB program health plan have several separate pieces that work together. There is no duplication of insurance coverage. The following summarizes how Original Medicare and a preferred-provider organization health plan work together to minimize, and most likely eliminate, out-of-pocket expenses. Original Medicare is primary insurance, and the FEHB health plan is secondary insurance.
- Medicare Part A helps pay for inpatient hospital and skilled nursing care, some home care and end-of-life hospice care.
- Medicare Part B covers doctors’ services, diagnostic screenings, durable medical equipment, lab tests, outpatient care and preventive services.
- Original Medicare (Part A and Part B) has no prescription drug coverage. FEHB program health plans provide prescription drug coverage, or a federal retiree can join a Prescription Drug Plan (PDP), which is a Medicare Part D drug plan.
- The FEHB health plan acts as a Medicare supplemental plan and pays a share of the costs that Original Medicare does not pay, including deductibles and copayments.
How Medicare Advantage Works
Federal retirees who choose a private Medicare Advantage plan have Medicare Part A, Medicare Part B and Medicare Part D all in one plan. The following is information on 2026 Medicare Advantage plans:
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- As of June 2026, Medicare Advantage plans had enrolled 51 percent, or 36.1 million, of Medicare’s 70.6 million beneficiaries, according to Centers for Medicare & Medicaid Services (CMS) monthly enrollment data.
- Federal retirees enrolled in Original Medicare who choose a private Medicare Advantage plan have to suspend their FEHB program enrollment.
- A Medicare Advantage beneficiary may need to use doctors in the plan’s network and get approval (prior authorization) for certain drugs or services.
- Medicare Advantage plans usually have different out-of-pocket costs than Original Medicare, including a yearly limit on out-of-pocket costs.
- Many Medicare Advantage plans offer extra benefits that Original Medicare does not cover, including dental, vision and other fringe benefits such as gym memberships and transportation assistance.
The following tables compare Original Medicare and Medicare Advantage in four areas: (1) doctor and hospital choice; (2) cost; (3) coverage within the US; and (4) coverage outside the US. In the tables, a “beneficiary” is an individual enrolled in Medicare.
Doctor and Hospital Choice
| Original Medicare | Medicare Advantage |
|---|---|
| A beneficiary can use any doctor or hospital that takes Medicare, anywhere in the US. The beneficiary pays more if the doctor does not accept Medicare assignment. | A beneficiary may need to use doctors and other providers who are in the plan’s network and service area for non-emergency care. Some plans offer non-emergency coverage out-of-network, but it may cost more. |
| In most cases, a beneficiary does not need a referral to use a specialist. | A beneficiary may need a referral to use a specialist. |
Cost
| Original Medicare | Medicare Advantage |
|---|---|
| For Part B covered services, the beneficiary pays 20 percent of the Medicare-approved amount after meeting the deductible. | Out-of-pocket costs vary. Plans may have different out-of-pocket costs for certain services. |
| The beneficiary pays a monthly Part B premium. A beneficiary who joins a Medicare drug plan to get Medicare drug coverage also pays a Part D monthly premium. | The beneficiary pays a monthly Part B premium and may also pay the Medicare Advantage plan premium. Most plans include Medicare drug coverage, so the beneficiary does not pay a separate Part D premium. |
| There is no yearly limit on what a beneficiary pays out-of-pocket unless the beneficiary has a Medicare supplement or Medigap plan. Federal retirees enrolled in an FEHB program health plan use that plan as a Medicare supplemental health plan. | Medicare Advantage plans have a yearly limit on what a beneficiary pays for covered Medicare services, including different limits for in-network and out-of-network services. Once a beneficiary reaches the plan’s limit, the beneficiary pays nothing for covered services for the rest of the calendar year. |
Coverage Within the US
| Original Medicare | Medicare Advantage |
|---|---|
| It covers most medically necessary services and supplies in hospitals, doctor offices and other health care facilities. Original Medicare does not cover some services, such as routine physical exams, eye exams and most dental care. | Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare does not cover, such as some vision, hearing and dental services. |
| In most cases, a beneficiary does not need approval (prior authorization) for Original Medicare to cover services or supplies. | A beneficiary may need to get approval (prior authorization) from the plan before the plan covers certain services or supplies. |
| A beneficiary can join a separate Medicare drug plan to get Medicare drug coverage (Medicare Part D). | Most plans include Medicare Part D, so a beneficiary does not need to join a separate Medicare Part D plan. |
Coverage Outside the US
| Original Medicare | Medicare Advantage |
|---|---|
| Original Medicare generally does not cover medical care outside the US. A federal retiree should check with the FEHB program health plan to find out about medical coverage outside the US. | Plans generally do not cover medical care outside the US. Some plans may offer an extra benefit that covers emergency and urgently needed services when traveling outside the US. |
What to Consider Before Choosing
When selecting Original Medicare or Medicare Advantage, a federal employee or retiree should consider these factors. Choosing the wrong type of Medicare can be costly, as covered in The Biggest Medicare Mistakes That Can Cost Federal Retirees.
- Costs. What premiums and out-of-pocket costs will the Medicare beneficiary have to pay?
- Provider access. What kind of providers can the Medicare beneficiary see? Does the beneficiary have to see in-network providers or get referrals? If so, are the doctors the beneficiary uses in the plan’s network?
- Drug coverage. Is drug coverage included in the plan, or can the beneficiary choose a different drug plan? Does the drug plan cover the drugs the beneficiary takes?
- Supplemental benefits. Does the Medicare Advantage plan cover extra services such as vision, hearing or dental? If so, is there an extra cost for these services?
- Out-of-pocket limit. Is there an annual limit on out-of-pocket costs in the Medicare Advantage plan? If so, what is the limit?
Where to Get Help Comparing Options
Federal retirees trying to decide which Medicare option fits their needs can get free help. A beneficiary’s State Health Insurance Assistance Program (SHIP) can help compare Medicare coverage options. SHIP counselors are funded by the federal government to provide trusted, unbiased Medicare counseling at no cost. Beneficiaries can find their state program through the SHIP National Technical Assistance Center.
Beneficiaries can also use the Medicare Plan Finder to find a Medicare Advantage plan.
Edward A. Zurndorfer is a Certified Financial Planner, Chartered Life Underwriter, Chartered Financial Consultant and IRS Enrolled Agent in Silver Spring, MD. Tax planning, federal employee benefits, retirement and insurance consulting services are offered through EZ Accounting and Financial Services, located at 833 Bromley Street Suite A, Silver Spring, MD 20902-3019, telephone 301-681-1652.
Edward A. Zurndorfer is a CERTIFIED FINANCIAL PLANNER®, Chartered Life Underwriter, Chartered Financial Consultant, Registered Health Underwriter and Enrolled Agent in Silver Spring, MD. Tax planning, Federal employee benefits, retirement and insurance consulting services offered through EZ Accounting and Financial Services, located at 833 Bromley Street Suite A, Silver Spring, MD 20902-3019