Page 66 - The Informed Fed--Hearn (edited 10.29.20)

A common misconception is that your spouse has to be enrolled for
five years prior to your retirement. This is not true. As long as your
spouse has other coverage, they can enroll in your plan either after a life-
changing event or during any open season. A pitfall to avoid here is that
if your spouse continues to work after you retire and keeps their own
health coverage thinking they’ll get on your plan when they retire, and
then the federal retiree passes away before the spouse has a chance to
retire. The spouse loses the access to those health benefits because they
were not covered by the FEHB at the time of the retiree’s passing. Even
if you take the survivor benefit to enable your spouse to continue health
benefits if you pass away first, and if the spouse is not covered by FEHB
on the day you die, they are unable to get FEHB coverage. Your overall
health care expenses include more than just your share of the premium.
You also have to take into consideration what your maximum
deductibles could be, as well as any co-pays for doctors, hospitalization
and prescriptions. In the case of the High-Deductible Health Plan, you
also get a rebate from the insurance company, so you get to deduct that
amount from your overall expenses.
Take a Look at the following illustration comparing out-of-pocket
expenses for an employee insuring self only:

Self Only HDHP Standard
Limit state in plan’s
summary of benefits $5,000 $4,500
Deductible Included $350
Hospital, physician, Included $2,560
drug copays
Specialty drug Included $4,000
Premium minus $88 $1,992
savings account
Actual limit to you $5,088 $13,402

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