Types of Medicare Coverage

This part provides general information about early Medicare coverage. For a more complete explanation of the Medicare program, please refer to booklet RB-20, "Medicare for Railroad Workers and Their Families".

Medicare is the Federal health insurance program for people age 65 or older and certain disabled people. One part of Medicare (Part A) provides hospital insurance benefits. Another part (Part B) provides supplementary medical insurance.

Hospital insurance helps pay for:

• Inpatient hospital care
• Inpatient care in a skilled nursing facility
• Home health care and hospice care

Supplementary medical insurance helps pay for:

• Doctor’s services
• Outpatient hospital services
• Durable medical equipment
• A number of other medical services and supplies that are not covered by hospital insurance

Eligibility Requirements for Early Medicare

To be eligible for Medicare coverage before age 65, a disabled widow(er) annuitant must:

• be at least age 50, and
• permanently disabled before the end of the prescribed period (see Part V, Item 6, for the definition of prescribed period).

An individual with permanent kidney failure (chronic renal disease) is eligible at any age. However, the Social Security Administration must be contacted for this coverage.

There are also special rules that apply for an individual diagnosed with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).

When Your Early Medicare Can Begin

Your Medicare coverage will begin on the later of:

• the first day of the 25th month you are entitled to receive annuity payments, or
• the first day of the 30th calendar month after your disability began.

When Your Early Medicare Could End

Medical Recovery

If it is determined that your condition has improved and that you are medically able to work, your Medicare coverage will end (see Part V, Item 3, for the definition of medical recovery). This is true whether or not you have actually worked. When this happens, your early Medicare coverage ends with the later of:

• the last day of the 2nd month after the month in which medical recovery occurs, or
• the last day of the month after the month in which you were notified in writing that your disability ended.

Work

If you are working, or have worked since your coverage began, your early Medicare coverage may end. This is true even though your medical condition may not have improved. Unless medical recovery occurs first, your early Medicare coverage ends with the earlier of:

• the last day of the 90th month after it is determined you performed regular work (see Part V, Item 7, for the definition of regular work), or
• the last day of the month in which death occurs.

Enrollment for Medicare

As soon as you are determined to be eligible for Medicare, you will automatically be enrolled for hospital insurance coverage (Part A). You pay nothing for this coverage. You will also be automatically enrolled for supplemental medical insurance coverage (Part B). You will have to pay a monthly premium for Part B. If you receive an annuity, the premium will usually be deducted from your monthly payments. If you choose not to receive Part B coverage, you must notify the Railroad Retirement Board.