Life can change in an instant. Reviewing your policy is critical to see what your plan covers and what it does not cover. Image: create jobs 51/Shutterstock.com
By: Abraham Grungold
Federal Employees and Retirees are very fortunate to have FEHB. The federal government pays approximately 75 percent of the premium and the employee or retiree pays the remaining 25 percent. If you are under Medicare A and B, most retirees have a Medicare Part B Supplemental Plan to pay for the 20 percent that Medicare Part B does not cover.
So, did you pick the right health plan?
When you are young and healthy, life seems simple and easy. You have a health plan that you may rarely use. Perhaps you go to the doctor once per year for your annual physical and during the year you may purchase some prescription medications for colds or allergies etc. I was that person during the early part of my federal career.
As I aged and I needed my first surgery at age 50. My physician said to me that I had a good run of 50 uncomplicated healthy years. At age 50, things are going to start popping up. Personally, I always carried the Blue Cross Blue Shield Preferred Provider Option health plan. I kept the same plan when I retired in Feb 2022. I never complained about my policy, and I did not need to obtain an authorization for a specialist, test and or surgery.
During the past ten years, I experienced many types of surgeries and testing such at CT and MRI scans. The copayment associated with these tests resulted in me reaching my maximum annual out of pocket limit. Over the years that amount varied from 6,000 to 7,500 per year. It sounds like a lot, but one CT scan can cost thousands and one surgery can cost tens of thousands.
During 2025, I had to undergo many medical procedures testing and surgeries. I reached my maximum out of pocket by February. On December 31, 2025, I checked the total amount billed to Blue Cross Blue Shield by all the medical providers which I had received medical services during the year.
The total amount for 2025, was 3.5 million dollars. My total out of pocket for 2025 was approximately $6,100.
Planning is important because, I made sure that I had completed as many of my medical services during 2025 and not having to carry them over into 2026. Also, my medical providers allowed me to be on a payment plan to pay off my $6,100. If I did not have my FEHB plan and Medicare Part A coverage, I would have to file for personal bankruptcy.
Life can change in an instant. Reviewing your policy is critical to see what your plan covers and what it does not cover. Many times, I would contact Blue Cross Blue Shield to ensure that my medical treatment was going to be covered or if I needed a medical interpretation of the service benefit.
If your plan does not cover a medical service that you may need and you are able to postpone that medical service, open season is the opportunity to switch to a FEHB plan that can meet your medical needs.
The same holds true for your spouse or dependent. You need to manage your health care expenses as you do any other household expenses.
Proper Planning Prevents Poor Performance.
Abraham Grungold is a retired federal employee with 36 years of federal service – including with the USPS Inspector General, the VA Inspector General, the US Dept of Justice, and the US Dept of Labor. Through his company AG Financial Services he helps federal employees with their TSP and federal retirement planning and decisions. Mr. Grungold has written over 50 articles regarding the TSP and FERS retirement and been a guest on several podcasts with the Federal News Radio and Government Executive Magazine.
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