§ 890.1604 - Medicare enrollment requirement for certain Postal Service annuitants and eligible family members.

§ 890.1604 Medicare enrollment requirement for certain Postal Service annuitants and eligible family members.

Cross Reference

Link to an amendment published at 89 FR 37078, May 6, 2024.

(a) Except as provided by paragraph (c)(1) of this section, a Postal Service Medicare covered annuitant may not (a) Annuitant. A Postal Service annuitant who is entitled to Medicare Part A must be enrolled in Medicare Part B to enroll or continue enrollment in a health benefits plan under this subpart unless the annuitant is entitled to benefits under Medicare Part A and enrolled in Medicare Part B.

(b) Except as

, except as otherwise provided by paragraph (

c

d)(

2

1) of this section

, where a

.

(b) Member of family. A Postal Service Medicare covered annuitant is a covered Medicare individual and is required to enroll 's member of family who is entitled to Medicare Part A must be enrolled in Medicare Part B in order to be enrolled covered or continue coverage in a health benefits plan under this subpart, a Medicare covered member of family of the Postal Service annuitant may not enroll in a health benefits plan under this subpart as a member of family of the Postal Service annuitant unless the member of family is enrolled in Medicare Part B.

(c) Pursuant to paragraph (d) of this section, the requirements under

unless:

(1) The Postal Service Medicare covered annuitant is excepted from the requirement to enroll in Medicare Part B as provided by paragraphs (d)(1)(i) through (v) of this section; or

(2) The member of family is excepted from the requirement to enroll in Medicare Part B as provided by paragraphs (d)(2)(i) through (iv) of this section.

(c) [Reserved]

(d) Exceptions. The Medicare Part B enrollment requirements provided in paragraphs (a) and (b) of this section

, as applicable, shall

do not apply

to the following individuals

:

(1)

A

To a Postal Service Medicare covered annuitant who—

(i)

As of

Was a Postal Service annuitant on or before January 1, 2025,

is a Postal Service annuitant who is

and who was not both entitled to Medicare Part A and enrolled in Medicare Part B on January 1, 2025;

(ii)

As of January 1, 2025, was

Was a Postal Service employee

who is at least

and was 64 years of age or older on January 1, 2025;

(iii) Resides outside the United States (which includes the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands), provided that the individual demonstrates such residency

to the Postal Service

;

(iv) Is enrolled in health care benefits provided by the Department of Veterans Affairs (VA) under 38 U.S.C. chapter 17, subchapter II, including individuals who are not required to enroll in the VA's system of patient enrollment referred to in 38 U.S.C. 1705(a), subject to the documentation requirements in paragraph (

d

e)(2) of this section; or

(v) Is eligible for health services from the Indian Health Service, subject to the documentation requirements in paragraph (

d

e)(3) of this section.

(2)

A

To a Medicare covered member of family who—

(i) Is eligible for PSHB coverage

based on

under the PSHB enrollment of a Postal Service Medicare covered annuitant who is not required to enroll in Medicare Part B

in order to be eligible for coverage under this subpart

, as provided in paragraphs (d)(1)(i) through (v) of this section;

(ii) Resides outside the United States (which includes the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands), provided that the individual demonstrates such residency

to the Postal Service

;

(iii) Is enrolled in health care benefits provided by the VA under 38 U.S.C. chapter 17, subchapter II, including individuals who are not required to enroll in the VA's system of patient enrollment referred to in 38 U.S.C. 1705(a) to receive VA hospital care and medical services, subject to the documentation requirements in paragraph (

d

e)(2) of this section; or

(iv) Is eligible for health services from the Indian Health Service subject to the documentation requirements in paragraph (

d

e)(3) of this section.

(

d

e) Documentation requirements. To qualify for an exception under paragraph (

c

d) of this section, a Postal Service Medicare covered annuitant, or a Medicare covered member of family must meet one of the following documentation requirements:

(1)

Demonstrating qualification

Documentation or information in a form, manner, and frequency as prescribed by OPM demonstrating qualification, satisfactory to the Postal Service, for the exceptions at

paragraphs

paragraph (

c

d)(1)(iii)

and

or (

c

d)(2)(ii) of this section;

(2) Documentation from the Department of Veterans Affairs in a form, manner, and frequency as prescribed by OPM demonstrating the individual meets an exception identified in

paragraphs

paragraph (

c

d)(1)(iv)

and

or (

c

d)(2)(iii), of this section; or

(3) Documentation from the Indian Health Service (IHS) in a form, manner, and frequency as prescribed by OPM in consultation with IHS demonstrating the individual meets an exception identified in

paragraphs

paragraph (

c

d)(1)(v)

and

or (

c

d)(2)(iv) of this section.

(

e)

f) Notification of non-enrollment in Part B. A Postal Service Medicare covered annuitant or a Medicare covered member of family

may

who is required to be enrolled in Medicare Part B must promptly notify the Postal Service or OPM, in writing, if they choose not to enroll in or to disenroll from Medicare Part B as described in § 890.1608(e).

This

(g) Effect of non-enrollment in Part B. Failure to enroll or disenrollment from Medicare Part B will have the effect of a termination of

coverage, pursuant to § 890.1608(b).(f) The process for disenrollment or removal from PSHB enrollment for non-enrollment in Medicare Part B is

PSHB coverage, as described in § 890.1608(b).

[89 FR 37078, May 6, 2024]