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Federal, State, and Local Government Workers

Employees and retirees of the federal, state, and/or local government have special considerations to make around Medicare. These considerations are based on when you were hired, what state you live in, and whether you paid into Medicare through your payroll taxes.

This section discusses common questions about first enrolling in Medicare, and how government employee/retiree coverage may work with Medicare.

I’m a federal employee/retiree with Federal Employee Health Benefits (FEHB). Should I enroll in Medicare when I turn 65?

Federal retirees with FEHB have some important decisions to make when first eligible for Medicare. Most enroll in Part A, since they paid for it while still working, and there is no additional premium. In most cases, Part A (covers hospital services) will pay first, FEHB will pay second.

You have the option to enroll in other parts of Medicare. The Office of Personnel Management has a helpful list of questions and answers for how to weigh those options, and how Medicare and FEHB coverage works together.

It is worth your time to review the financial considerations of enrolling in different parts of Medicare, including whether you will incur any penalties for late enrollment.

Get personalized help in reviewing your options.

What about if I work for a state or local government?

If you are a state or local government employee/retiree who was hired after March 31, 1986, then you are eligible for Medicare coverage. Before this date, state and local government employees were exempt from paying Federal Insurance Contributions Tax (FICA) payroll taxes that help to pay for Medicare Part A. Therefore, if you were hired after this date, as long as you have enough working credits, you will be eligible for premium-free Part A.

Prior to March 31, 1986, state and local government employees were exempt from paying the FICA tax. Some states, however, entered into agreements (called Section 218 Agreements) with Social Security, essentially agreeing to pay toward the Part A portion so these employees would be eligible for Medicare. Social Security reports that all states currently have a Section 218 Agreement in place, however, the extent of coverage varies.

You can learn more about this in the Social Security publication, How State and Local Government Employees Are Covered by Social Security and Medicare.

If you were employed or retired prior to March 1986, you should contact your local Social Security Administration office or your state Office of Personnel to find out the extent of the agreement in your state.

You might also want to get personal help in exploring your Medicare coverage.

How does my government employee/retiree coverage work with Medicare?

You can learn more about how your government employee/retiree coverage coordinates with Medicare in the official Medicare publication, Who Pays First?

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