The Federal Medicare program provides
hospital and medical insurance protection for railroad
retirement annuitants and their families, just as it does for
social security beneficiaries. Medicare has the following parts:
Medicare Part A (hospital insurance)
helps pay for inpatient care in hospitals and skilled nursing
facilities (following a hospital stay), some home health care
services, and hospice care. Part A is financed through payroll
taxes paid by employees and employers.
Medicare Part B
(medical insurance) helps pay for
medically-necessary services like doctors'
services and outpatient care. Part B also helps
cover some preventive services. Part B is
financed by premiums paid by participants and by
Federal general revenue funds
Medicare Part C
(Medicare Advantage Plans) is another way to get Medicare
benefits. It combines Part A, Part B, and sometimes, Part D
(prescription drug) coverage. Medicare Advantage Plans are
managed by private insurance companies approved by Medicare.
D (Medicare prescription drug coverage) offers
voluntary insurance coverage for prescription drugs through
Medicare prescription drug plans and other health plan options.
The following questions and answers provide basic information on
Medicare eligibility and coverage, as well as other information
on the Medicare program.
1. Who is eligible for Medicare?
All railroad retirement beneficiaries age 65 or over and other
persons who are directly or potentially eligible for railroad
retirement benefits are covered by the program. Although the age
requirements for some unreduced railroad retirement benefits
have risen just like the social security requirements,
beneficiaries are still eligible for Medicare at age 65.
Coverage before age 65 is available for disabled employee
annuitants who have been entitled to monthly benefits based on
total disability for at least 24 months and have a disability
insured status under social security law. There is no 24-month
waiting period for those who have ALS (Amyotrophic Lateral
Sclerosis), also known as Lou Gehrig's disease.
If entitled to monthly benefits based on an occupational
disability, and the individual has been granted
a disability freeze, he or she is eligible for Medicare starting
with the 30th month after the freeze date or, if later, the 25th
month after he or she became entitled to monthly benefits. If
receiving benefits due to occupational disability and the person
has not been granted a disability freeze, he or
she is generally eligible for Medicare at age 65. (The standards
for a disability freeze determination follow social security law
and are comparable to the medical criteria a person must meet to
be granted a total disability.)
Under certain conditions, spouses, divorced spouses, surviving
divorced spouses, widow(er)s, or a dependent parent may be
eligible for Medicare hospital insurance based on an employee's
work record when the spouse, etc., turns age 65. Also, disabled
widow(er)s under age 65, disabled surviving divorced spouses
under age 65, and disabled children may be eligible for
Medicare, usually after a 24-month waiting period.
Medicare coverage at any age on the basis of permanent kidney
failure requiring hemodialysis or receipt of a kidney transplant
is also available to employee annuitants, employees who have not
retired but meet certain minimum service requirements, spouses,
and dependent children. The Social Security Administration has
jurisdiction of Medicare in these cases. Therefore, a social
security office should be contacted for information on coverage
for kidney disease.
2. How do persons enroll in Medicare?
If a retired employee, or a family member, is receiving a
railroad retirement annuity, enrollment for both Medicare Part A
and Part B is generally automatic and coverage begins when the
person reaches age 65. For beneficiaries who are totally and
permanently disabled, both Medicare Part A and Part B start
automatically with the 30th month after the beneficiary became
disabled or, if later, the 25th month after the beneficiary
became entitled to monthly benefits. Even though enrollment is
automatic, an individual may decline Part B; this does not
prevent him or her from applying for Part B at a later date.
However, premiums may be higher if enrollment is delayed. (See
question 5 for more information on delayed enrollment.)
If an individual is eligible for, but not receiving an annuity,
he or she should contact the nearest Railroad Retirement Board
(RRB) office before attaining age 65 and apply for both Part A
and Part B. (This does not mean that the individual must retire,
if presently working.) The best time to apply is during the 3
months before the month in which the individual reaches age 65.
He or she will then have both Part A and Part B protection
beginning with the month age 65 is reached. If the individual
does not enroll for Part B in the 3 months before attaining age
65, he or she can enroll in the month age 65 is reached, or
during the 3 months that follow, but there will be a delay of 1
to 3 months before Part B is effective. Individuals who do not
enroll during this "initial enrollment period" may sign up in
any "general enrollment period" (January 1 - March 31 each
year). Coverage for such individuals begins July 1 of the year
3. Are there costs associated with Medicare Part A
Yes. While individuals don't have to pay a premium to receive
Medicare Part A, recipients of Part A benefits are billed by the
hospital for a deductible amount ($1,216 in 2014), as well as
any coinsurance amount due and any noncovered services. The
remainder of the bill from the hospital, as well as bills for
services in skilled nursing facilities or home health visits, is
sent to Medicare to pay its share.
4. What are the costs associated with Medicare Part B
Anyone eligible for Medicare hospital insurance (Part A) can
enroll in Medicare medical insurance (Part B) by paying a
monthly premium. The standard premium is $104.90 in 2014.
Monthly premiums for some beneficiaries are greater, depending
on a beneficiary's or married couple's modified adjusted gross
income. The income-related Part B premiums for 2014 are $146.90,
$209.80, $272.70, or $335.70, depending on the extent to which
an individual beneficiary's modified adjusted gross income
exceeds $85,000 ($170,000 for a married couple), with the
highest premium rates only paid by beneficiaries whose modified
adjusted gross incomes are over $214,000 ($428,000 for a married
There is also an annual deductible ($147 in 2014) for Part B
Palmetto GBA, a subsidiary of Blue Cross and Blue Shield,
generally processes claims for Part B benefits filed on behalf
of railroad retirement beneficiaries in the Original Medicare
Plan (the traditional fee-for-service Medicare plan). An
individual in the Original Medicare Plan should have his or her
hospital, doctor, or other health care provider submit Part B
claims directly to:
Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001
Persons with questions about Part B claims
under the Original Medicare Plan can contact Palmetto GBA as
5. Can Medicare Part B premiums increase for delayed
Yes. Premiums for Part B are increased 10 percent for each
12-month period the individual could have been, but was not,
enrolled. However, individuals age 65 or older who wait to
enroll in Part B because they have group health plan coverage
based on their own or their spouse's current employment may not
have to pay higher premiums because they may be eligible for
"special enrollment periods." The same special enrollment period
rules apply to disabled individuals, except that the group
health insurance may be based on the current employment of the
individual, his or her spouse, or a family member.
Individuals deciding when to enroll in Medicare Part B must
consider how this will affect eligibility for health insurance
policies which supplement Medicare coverage. These include "Medigap"
insurance and prescription drug coverage, and are explained in
the answers to questions 6 through 8.
6. What is Medigap insurance?
Many private insurance companies sell insurance, called "Medigap"
for short, that helps pay for services not covered by the
Original Medicare Plan. Policies may cover deductibles,
coinsurance, copayments, health care outside the United States
and more. Generally, individuals need Medicare Part A and Part B
to enroll, and a monthly premium is charged. When someone first
enrolls in Medicare Part B at age 65 or older, he or she has a
6-month "Medigap open enrollment period." During this period, an
insurance company cannot deny coverage, place conditions on a
policy, or charge more for a policy because of past or present
7. Do Medicare beneficiaries have choices available for
receiving health care services?
Yes. Under the Original Medicare Plan, the fee-for-service
Medicare plan that is available nationwide, a beneficiary can
see any doctor or provider who accepts Medicare and is accepting
new Medicare patients.
However, a beneficiary may opt to choose a Medicare Advantage
Plan (Part C) instead. These plans are managed by
Medicare-approved private insurance companies. Medicare
Advantage Plans combine Medicare Part A and Part B coverage, and
are available in most areas of the country. An individual must
have Medicare Part A and Part B to join a Medicare Advantage
Plan, and must live in the plan's service area. Medicare
Advantage Plan choices include regional preferred provider
organizations (PPOs), health maintenance organizations (HMOs),
private fee-for-service plans and others. A PPO is a plan under
which a beneficiary uses doctors, hospitals, and providers
belonging to a network; beneficiaries can use doctors,
hospitals, and providers outside the network for an additional
cost. Under a Medicare Advantage Plan, a beneficiary may pay
lower copayments and receive extra benefits. Most plans also
include Medicare prescription drug coverage (Part D).
8. How do Medicare prescription drug plans work?
Medicare contracts with private companies to offer beneficiaries
voluntary prescription drug coverage through a variety of
options, with different covered prescriptions and different
costs. Beneficiaries pay a monthly premium (averaging about $32
in 2014), a yearly deductible (up to $310 in 2014) and part of
the cost of prescriptions. Those with limited income and
resources may qualify for help in paying some prescription drug
The Affordable Care Act requires some Part D beneficiaries to
also pay a monthly adjustment amount, depending on a
beneficiary's or married couple's modified adjusted gross
income. The Part D income-related monthly adjustment amounts in
2014 are $12.10, $31.10, $50.20, or $69.30, depending on the
extent to which an individual beneficiary's modified adjusted
gross income exceeds $85,000 ($170,000 for a married couple),
with the highest amounts only paid by beneficiaries whose
incomes are over $214,000 ($428,000 for a married couple).
To enroll, individuals must have Medicare Part A and live in the
prescription drug benefit plan's service area. Beneficiaries can
join during the period that starts 3 months before the month
their Medicare coverage starts and ends 3 months after that
month. There may be a higher premium if an individual
doesn't join a Medicare drug plan when first eligible.
In most cases, there is no automatic enrollment to get a
Medicare prescription drug plan. Individuals enrolled in
Medicare Advantage Plans will generally get their prescription
drug coverage through their plan.
9. Where can I get more information about the Medicare
Railroad retirement beneficiaries should contact the RRB
toll-free at 1-877-772-5772 for general information on their
More detailed information on Medicare's benefits, costs, and
health care options is available from the Center for Medicare &
Medicaid Services (CMS) publication Medicare & You, which is
mailed to Medicare beneficiary households each fall and to new
Medicare beneficiaries when they become eligible for coverage.
Medicare & You and other publications are also available by
visiting Medicare's website, www.medicare.gov, or by calling the
Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227).