Zoe
Elite Member
- Joined
- Sep 15, 2020
- Professional Status
- Certified General Appraiser
- State
- Tennessee
Other Health Benefits for Current Members of Congress
Office of the Attending Physician
Current Members are eligible to receive limited services from the Office of the Attending Physician in the U.S. Capitol for an annual fee. Services include routine exams, consultations, and certain diagnostic tests. The office does not provide vision or dental care, and prescriptions can be written but not dispensed.<a href="https://www.congress.gov/crs-product/R43194#fn27" name="ifn27" title="For background information on the Office of the Attending Physician, see CRS Report RL33220, Support Offices in the House of Representatives: Roles and Authorities , by Ida A. Brudnick .">27</a>
Military Treatment Facilities
Current Members are also authorized to receive medical and emergency dental care at military treatment facilities. There is no charge for outpatient care if it is provided in the National Capital Region.<a href="https://www.congress.gov/crs-product/R43194#fn28" name="ifn28" title="The National Capital Region includes Washington, DC , and nearby jurisdictions in Maryland and Virginia.">28</a> For inpatient care, Members are billed at full reimbursement based on rates set by the Department of Defense. Outside the National Capital Region, charges are at full reimbursement rates for both inpatient and outpatient care provided to current Members of Congress. Members pay out of pocket for expenses not covered by insurance. Dependents and former Members are not eligible for care at military treatment facilities.<a href="https://www.congress.gov/crs-product/R43194#fn29" name="ifn29" title="32 C.F.R. §728.77.">29</a>
Medicare
Medicare is the nation's health insurance program for individuals aged 65 and over and certain people with disabilities. Medicare consists of four distinct parts: Part A, or Hospital Insurance (HI); Part B, or Supplementary Medical Insurance (SMI); Part C, or Medicare Advantage (MA); and Part D, the prescription drug benefit.<a href="https://www.congress.gov/crs-product/R43194#fn30" name="ifn30" title="For more detail on Medicare eligibility and benefits, see CRS Report R40425, Medicare Primer .">30</a> Workers, including all federal employees, Members, and congressional staff, must pay a tax on their wages for Medicare Part A.<a href="https://www.congress.gov/crs-product/R43194#fn31" name="ifn31" title="Internal Revenue Service, Topic 751 - Social Security and Medicare Withholding Rates , https://www.irs.gov/taxtopics/tc751.html .">31</a> Participation in Part B, Medicare Advantage, and Part D is voluntary, and enrollees may need to pay a premium. Medicare beneficiaries may also choose to purchase a Medigap policy, which provides supplemental coverage in the private sector if one enrolls in Medicare Part A and B.
With respect to Members and designated congressional staff, Section 1312(d)(3)(D) of the ACA and the OPM final rule do not affect their eligibility for any Medicare programs. Additionally, OPM indicates that eligibility for Medicare does not affect Members' and staff's ability to obtain coverage through a SHOP exchange:
SHOP coverage is not subject to the same limitation as the individual Exchange which precludes an individual from carrying both Medicare and an individual Exchange policy. You can continue to have Medicare coverage in addition to your employer-sponsored DC SHOP plan.<a href="https://www.congress.gov/crs-product/R43194#fn32" name="ifn32" title="OPM, Insurance FAQs: Members of Congress & Staff, http://www.opm.gov/healthcare-insurance/insurance-faqs/?cid=6bf9dd32-d3b9-4fc7-9416-431e535f933a/ .">32</a>
Members and designated staff who become eligible for Medicare while actively employed can have DC SHOP coverage and Medicare coverage concurrently. For those Members and designated staff who carry their federally sponsored health insurance coverage into retirement, they would switch to a plan offered under FEHB, and their FEHB coverage would interact with Medicare coverage in the ways outlined for the program
Office of the Attending Physician
Current Members are eligible to receive limited services from the Office of the Attending Physician in the U.S. Capitol for an annual fee. Services include routine exams, consultations, and certain diagnostic tests. The office does not provide vision or dental care, and prescriptions can be written but not dispensed.<a href="https://www.congress.gov/crs-product/R43194#fn27" name="ifn27" title="For background information on the Office of the Attending Physician, see CRS Report RL33220, Support Offices in the House of Representatives: Roles and Authorities , by Ida A. Brudnick .">27</a>
Military Treatment Facilities
Current Members are also authorized to receive medical and emergency dental care at military treatment facilities. There is no charge for outpatient care if it is provided in the National Capital Region.<a href="https://www.congress.gov/crs-product/R43194#fn28" name="ifn28" title="The National Capital Region includes Washington, DC , and nearby jurisdictions in Maryland and Virginia.">28</a> For inpatient care, Members are billed at full reimbursement based on rates set by the Department of Defense. Outside the National Capital Region, charges are at full reimbursement rates for both inpatient and outpatient care provided to current Members of Congress. Members pay out of pocket for expenses not covered by insurance. Dependents and former Members are not eligible for care at military treatment facilities.<a href="https://www.congress.gov/crs-product/R43194#fn29" name="ifn29" title="32 C.F.R. §728.77.">29</a>
Medicare
Medicare is the nation's health insurance program for individuals aged 65 and over and certain people with disabilities. Medicare consists of four distinct parts: Part A, or Hospital Insurance (HI); Part B, or Supplementary Medical Insurance (SMI); Part C, or Medicare Advantage (MA); and Part D, the prescription drug benefit.<a href="https://www.congress.gov/crs-product/R43194#fn30" name="ifn30" title="For more detail on Medicare eligibility and benefits, see CRS Report R40425, Medicare Primer .">30</a> Workers, including all federal employees, Members, and congressional staff, must pay a tax on their wages for Medicare Part A.<a href="https://www.congress.gov/crs-product/R43194#fn31" name="ifn31" title="Internal Revenue Service, Topic 751 - Social Security and Medicare Withholding Rates , https://www.irs.gov/taxtopics/tc751.html .">31</a> Participation in Part B, Medicare Advantage, and Part D is voluntary, and enrollees may need to pay a premium. Medicare beneficiaries may also choose to purchase a Medigap policy, which provides supplemental coverage in the private sector if one enrolls in Medicare Part A and B.
With respect to Members and designated congressional staff, Section 1312(d)(3)(D) of the ACA and the OPM final rule do not affect their eligibility for any Medicare programs. Additionally, OPM indicates that eligibility for Medicare does not affect Members' and staff's ability to obtain coverage through a SHOP exchange:
SHOP coverage is not subject to the same limitation as the individual Exchange which precludes an individual from carrying both Medicare and an individual Exchange policy. You can continue to have Medicare coverage in addition to your employer-sponsored DC SHOP plan.<a href="https://www.congress.gov/crs-product/R43194#fn32" name="ifn32" title="OPM, Insurance FAQs: Members of Congress & Staff, http://www.opm.gov/healthcare-insurance/insurance-faqs/?cid=6bf9dd32-d3b9-4fc7-9416-431e535f933a/ .">32</a>
Members and designated staff who become eligible for Medicare while actively employed can have DC SHOP coverage and Medicare coverage concurrently. For those Members and designated staff who carry their federally sponsored health insurance coverage into retirement, they would switch to a plan offered under FEHB, and their FEHB coverage would interact with Medicare coverage in the ways outlined for the program
