FEHB, FLTCIP, TSP, or Medicaid: Which One Actually Helps With a Specific Care Need?

Federal retirees in this metro are often juggling four or five potential funding sources at once, and not all of them apply to a given care need. This page walks through the most common questions in the order they tend to come up.

"Will FEHB pay for this?"

Only if it's medical care - a hospital stay, doctor visits, or a Medicare-aligned skilled-nursing stay tied to active recovery. FEHB does not pay for the custodial-care and room-and-board cost of ongoing assisted living. See FEHB vs. assisted living for the full picture.

"Do I have FLTCIP coverage I can use?"

Only if you already enrolled before the suspension. As of July 2026, OPM has extended the suspension on new FLTCIP applications through at least December 2026. If you're already covered, use your policy as intended. If you're not, this option isn't currently available - see the current FLTCIP status.

"Can I use my TSP balance?"

Yes, this is usually the most flexible source. Traditional and Roth TSP withdrawals, sequenced thoughtfully against RMD requirements and tax brackets, can fund a meaningful share of an assisted living or in-home care bill. See TSP withdrawals for care costs.

"Does my annuity help?"

It's fixed monthly income you can budget against - useful, but rarely enough on its own for a full assisted living bill in this metro's price range. It also becomes a countable income source if the family later applies for Medicaid. See the annuity/Medicaid interplay.

"What about private long-term-care insurance?"

Worth exploring, especially since FLTCIP is closed to new applicants. Private LTC insurance and hybrid life/LTC policies remain available, medically underwritten. See private LTC insurance alternatives.

"What happens when everything else runs out?"

Medicaid, once assets are spent down to the jurisdiction's limit. This is the backstop, not the starting point, and each of DC, Maryland, and Virginia runs its own Medicaid long-term-care program with different rules.