TRICARE and FEHB: which pays first

Who ends up with both

Retire from the uniformed services, then take a federal civilian job, and you are eligible for two group health programmes at once. Nothing stops you holding both, and the rules differ depending on whether you are working or retired, and whether you are 65.

Who pays first, at each stage

TRICARE generally pays after other health insurance, which is why it sits behind FEHB while you are employed. Carry both cards to every appointment, and tell each plan about the other.

The suspension rule

This is the part worth knowing well. A federal annuitant covered by TRICARE can suspend FEHB rather than cancel it.

• The FEHB premium stops entirely while suspended.
• You can unsuspend during any open season and pick any available plan.
• You can suspend again later, and there is no limit on how often you switch.
• An involuntary loss of the other coverage lets you come back immediately rather than waiting.
• Employees cannot do this. Suspension is only available once you have retired from federal service.

Suspend, never cancel

Cancelling FEHB as an annuitant is close to irreversible: you generally cannot re-enroll later. Suspending keeps the door open permanently. The two words sit next to each other on the form and mean entirely different things, so be explicit with OPM Retirement Services about which one you are doing, and keep the confirmation.

The five-year test

To carry FEHB into retirement you need five continuous years of coverage immediately before you retire, and time covered by TRICARE counts toward that test. What TRICARE does not do is replace the requirement to be enrolled in FEHB at the moment you retire.

The practical consequence: a military retiree who relied on TRICARE for most of a federal career can still qualify, but needs an FEHB enrollment in force on the day they retire. Getting that wrong ends the option permanently, so plan the timing with your HR office well before your retirement date.

Is paying for both worth it?

• While working: often yes for a stretch, because FEHB pays first and TRICARE mops up much of what is left, which can mean very low out-of-pocket costs.
• Different networks: the main practical benefit. FEHB can reach providers TRICARE does not.
• Family situation matters: a spouse ageing into Medicare, or children ageing out of TRICARE at different points, changes the answer.
• Once retired, most people suspend rather than pay two premiums, and keep FEHB in reserve.

Common questions