You’re not the only CSRS retiree who wants to know about their Medicare options. As of 2022, there were still about 44,000 federal employees in the Civil Service Retirement System, and many of them are getting close to retirement age and have questions about their health insurance. I have put together the most up-to-date information on how Medicare works for CSRS retirees to help you understand it.
Understanding CSRS and Medicare Eligibility
First things first: yes, CSRS retirees can usually get Medicare. People who work for CSRS don’t pay into Social Security, but they do pay the Medicare tax (currently 1. 45% of gross income) since 1983. This means that most CSRS retirees can get Medicare when they turn 65.
Here’s what you need to know about qualifying for Medicare
- You’re eligible for premium-free Medicare Part A if you or your spouse worked and paid Medicare taxes for at least 40 quarters (about 10 years)
- All federal employees, including CSRS participants, pay Medicare taxes
- About 70% of federal retirees enroll in Medicare Part B (which requires paying an additional premium)
Medicare Parts A and B for CSRS Retirees
Medicare Part A (Hospital Insurance)
Medicare Part A covers
- Inpatient hospital care
- Skilled nursing facility care following a hospital stay
- Home health care
- Hospice care
- Blood (after the first three pints)
Part A is free for most CSRS retirees who paid taxes on Medicare for 10 years. For most federal retirees, this makes it clear that they need to sign up for Part A.
Medicare Part B (Medical Insurance)
Medicare Part B covers:
- Doctor’s services
- Outpatient hospital care
- Ambulance services
- Durable medical equipment
- Many preventive services
Unlike Part A, Part B always comes with a monthly premium. In 2025, the standard Part B premium is $185 per month, but it can be higher based on your income. If your reported earnings were more than $106,000 in 2023, you’ll pay an additional Income-Related Monthly Adjustment Amount (IRMAA).
FEHB and Medicare: How They Work Together
As a CSRS retiree, you likely have access to the Federal Employees Health Benefits (FEHB) Program. The good news is you can keep your FEHB coverage after retirement if you:
- Have federal health insurance when you retire
- Had continuous FEHB coverage (or TRICARE/CHAMPUS) for 5 continuous years or since you became eligible
- Begin receiving annuity payments within 30 days
So, if you already have FEHB, should you sign up for Medicare? That depends on your situation.
Option 1: Keep FEHB Only
You’re not required to enroll in Medicare. Many CSRS retirees choose to keep just their FEHB plan. Advantages include:
- One premium instead of two
- Continued comprehensive coverage
- No need to navigate Medicare’s complex system
Option 2: Enroll in Medicare Part A and Keep FEHB
Since Part A is premium-free for most, many retirees choose to enroll in Part A while keeping their FEHB plan. This gives you:
- Extra hospital coverage at no additional premium cost
- FEHB as your primary coverage for other medical needs
Option 3: Enroll in Medicare Parts A and B with FEHB
About 70% of federal retirees choose this option. When you have both:
- Medicare becomes your primary payer
- FEHB becomes secondary (wraparound coverage)
- FEHB may cover the 20% coinsurance that Medicare Part B doesn’t pay
- You’ll pay both your FEHB premium and the Medicare Part B premium
Medicare Advantage (Part C) and CSRS Retirees
Medicare Advantage (Part C) offers an alternative to Original Medicare. These plans:
- Are offered by private insurance companies
- Provide all Part A and Part B benefits
- Often include prescription drug coverage
- May offer additional benefits
For CSRS retirees considering Medicare Advantage:
- You must be enrolled in both Parts A and B to join
- You can suspend your FEHB coverage to try Medicare Advantage
- You can later return to FEHB if you’re dissatisfied with Medicare Advantage
Prescription Drug Coverage: Medicare Part D vs. FEHB
Most FEHB plans include prescription drug coverage that is as good as or better than Medicare Part D. Because of this, many CSRS retirees don’t need to enroll in Part D.
If you decide to enroll in Part D later and didn’t have creditable coverage, you might face a late enrollment penalty. Fortunately, FEHB prescription coverage is typically considered “creditable,” so you won’t face penalties if you decide to switch to Part D later.
Enrollment Periods and Deadlines
Don’t miss these important enrollment windows:
Initial Enrollment Period (IEP)
This 7-month period begins 3 months before you turn 65. If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Parts A and B. Otherwise, you need to apply.
Special Enrollment Period (SEP)
If you’re covered by current employment (yours or your spouse’s), you qualify for an 8-month SEP that starts when employment or coverage ends.
General Enrollment Period (GEP)
If you miss other enrollment periods, you can sign up during the GEP from January 1 to March 31 each year, with coverage starting July 1.
Warning: If you delay enrolling in Part B without qualifying for an SEP, you’ll face a 10% premium increase for each 12-month period you could have been enrolled but weren’t.
Making the Right Choice for Your Situation
When deciding between Medicare and FEHB (or both), consider:
- Your health needs: Do you have chronic conditions requiring frequent care?
- Your budget: Can you afford both premiums?
- Your preferred doctors: Do they accept Medicare?
- Your location: Are Medicare providers accessible in your area?
Common Questions from CSRS Retirees
Do I need Medicare Part B if I have FEHB?
You don’t have to take Part B if you don’t want it, and your FEHB plan can’t require you to take it. However, having both provides more comprehensive coverage.
When did federal employees start paying into Medicare?
Federal employees have been paying into Medicare since 1983, even CSRS employees who don’t pay Social Security taxes.
What if I’m a CSRS Offset employee?
CSRS Offset employees pay into both Social Security and Medicare, so they’re eligible for both programs upon retirement.
Getting Help with Medicare Decisions
If you’re feeling overwhelmed by all these options, you’re not alone! Fortunately, there are resources to help:
- Contact your local State Health Insurance Assistance Program (SHIP) at 877-839-2675 or email [email protected]
- Review the Medicare & You handbook
- Consult the FEHB Handbook
- Visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227)
Final Thoughts
As a CSRS retiree, you have several options for healthcare coverage in retirement. While most CSRS retirees will benefit from enrolling in premium-free Medicare Part A, the decision about Part B requires more careful consideration of your personal circumstances.
Remember, there’s no one-size-fits-all answer. The best approach is to carefully evaluate your health needs, financial situation, and preferences to make an informed decision.
Have you already made decisions about Medicare as a CSRS retiree? What factors influenced your choice? Share your experiences in the comments below!
