Medicare for Railroad Workers and Their Families

U.S. Railroad Retirement Board

www.rrb.gov

MEDICARE
For Railroad Workers and Their Families

U.S. Railroad Retirement Board
Mission Statement
The Railroad Retirement Board’s mission is to
administer retirement/survivor and unemployment/sickness
insurance benefit programs for railroad workers and
their families under the Railroad Retirement Act and the
Railroad Unemployment Insurance Act. These programs
provide income protection during old age and in the event
of disability, death or temporary unemployment and
sickness. The Railroad Retirement Board also administers
aspects of the Medicare program and has administrative
responsibilities under the Social Security Act and the
Internal Revenue Code.
In carrying out its mission, the Railroad Retirement
Board will pay benefits to the right people, in the right
amounts, in a timely manner, and will take appropriate
action to safeguard our customers’ trust funds. The Railroad
Retirement Board will treat every person who comes into
contact with the agency with courtesy and concern, and
respond to all inquiries promptly, accurately and clearly.

Why You Should Read This Booklet
The Medicare program covers railroad workers just
like workers under social security. Railroad retirement
payroll taxes include a Medicare hospital insurance tax just
like social security payroll taxes.
Though you’re paying into the Medicare program
during your working years, and will probably rely on its
services in the future, you may not know what benefits
the program offers. The basic information in this booklet
provides an overview of the Medicare program.

What’s Inside
What is Medicare? .....................................................
Who can get Medicare? .............................................
How much does Medicare cost?..................................
Signing up for Medicare ...........................................
If you have other health insurance ............................
Options for receiving health care services ................
Medical insurance claims .........................................
Prescription drug coverage .......................................

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13
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More detailed information on Medicare’s benefits,
costs, and health service options is available from the
Centers for Medicare & Medicaid Services (CMS)
publication Medicare & You, which is mailed to Medicare
beneficiary households each fall and to new beneficiaries
when they become eligible for coverage. This and other
publications are available online at www.medicare.gov or
by calling toll-free 1-800-MEDICARE (1-800-633-4227),
TTY/TDD 1-877-486-2048.

This booklet is for general information.
It does not cover certain limitations,
exceptions and special cases.

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WHAT IS MEDICARE?
Medicare is our country’s health insurance program for
people age 65 or older, certain people with disabilities who
are under age 65, and people of any age who have permanent kidney failure. It provides basic protection against the
cost of health care, but it doesn’t cover all medical expenses
or the cost of most long-term care.
A portion of railroad retirement tier I and social security
payroll taxes paid by employees and employers finances
Medicare. It is also financed in part by monthly premiums
paid by enrollees.
CMS is the agency in charge of the Medicare program.
The Railroad Retirement Board (RRB) enrolls railroad
retirement beneficiaries in the program, deducts Medicare
premiums from monthly benefit payments, and assists in
certain other ways.
Medicare Includes
• Hospital Insurance (also called Medicare Part A),
which helps pay for inpatient care in hospitals and skilled
nursing facilities (following a hospital stay), some home
health care services, and hospice care.
• Medical Insurance (also called Medicare Part B),
which helps pay for doctors’ services, and many other
medical services and supplies that are not covered by
hospital insurance. These include laboratory services, home
health care services, outpatient hospital services, blood
replacement, and preventive services, among others.
• Medicare Advantage Plans (also called Medicare
Part C), as described in more detail on page 12.
• Prescription Drug Coverage (also called Medicare
Part D), as described in more detail on pages 13-15.

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A Word About Medicaid
You may think that Medicaid and Medicare are two
different names for the same program. Actually, they are
two different programs. Medicaid is a State-run program
designed primarily to help those with low income and few
resources. Each State has its own rules about who is eligible
and what is covered under Medicaid. Some people qualify
for both Medicare and Medicaid. For more information
about the Medicaid program, contact your local medical assistance agency, social services, or welfare office.

WHO CAN GET MEDICARE?
Hospital Insurance (Part A)
If you are age 65 or older.--Most people age 65 or older
who are citizens or permanent residents of the United States
are eligible for free Medicare hospital insurance (Part A).
You are eligible at age 65 if you receive or are eligible to
receive railroad retirement or social security benefits.
(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.)
If you are under age 65.--Before age 65, you are eligible for free Medicare hospital insurance if you have been
entitled to monthly benefits based on a total disability for at
least 24 months and have a disability insured status under
social security law. If you are entitled to monthly benefits
based on an occupational disability, and have been granted
a disability freeze, you are eligible for Medicare starting
with the 30th month after the freeze date or, if later, the 25th
month after you became entitled to monthly benefits. If you
receive benefits due to occupational disability and have not
been granted a disability freeze, you are generally eligible
for Medicare hospital insurance at age 65. (The standards for

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a disability freeze determination follow social security law
and are comparable to the medical criteria for granting total
disability.) You are also eligible for Medicare if you have
Lou Gehrig’s disease (amyotrophic lateral sclerosis).
Eligibility for family members.--Under certain
conditions, your spouse, divorced spouse, surviving
divorced spouse, widow(er), or a dependent parent may be
eligible for Medicare hospital insurance based on your work
record when he or she 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.
If you have permanent kidney failure.--If you have
permanent kidney failure, you are eligible for free Medicare
hospital insurance at any age. This is true if you receive
maintenance dialysis or a kidney transplant and you are
eligible for or are receiving monthly benefits under the
railroad retirement or social security system.
In addition, your spouse, divorced spouse or child may
be eligible, based on your work record, if she or he has
permanent kidney failure and receives maintenance dialysis
or a kidney transplant.
Medical Insurance (Part B)
Anyone eligible for free Medicare hospital insurance
can enroll in Medicare medical insurance (Part B) by paying
a monthly premium. The standard premium rate for new
enrollees is $134.00 in 2018. However, some beneficiaries
will pay slightly less than this amount because of a provision
in the law that premiums for current enrollees cannot
increase by more than the cost-of-living increase in social
security benefits. As a result, a little more than one-fourth of
Medicare enrollees will see increased premiums but pay less
than the full amount.
Monthly premiums for some beneficiaries are greater
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depending on their modified adjusted gross income. The
income-related Part B premiums for 2018 are $187.50,
$267.90, $348.30, or $428.60, depending on how much a
beneficiary’s adjusted gross income exceeds $85,000 (or
$170,000 for a married couple). Only beneficiaries whose
modified adjusted gross income exceeds $160,000 (or
$320,000 for a married couple) pay the highest premium.
The Social Security Administration (SSA) is responsible
for determining all income-related monthly adjustment
amounts. To do this, SSA uses the most recent tax return
information provided by the IRS. For 2018, in most cases
that is the beneficiary’s 2016 tax return. If that is not
available, SSA uses information from the 2015 tax return.

HOW MUCH DOES MEDICARE COST?
In addition to the monthly premiums you pay, there
are other out-of-pocket costs for Medicare which may also
change each year. These costs, known as “deductibles” and
“coinsurance,” are the amounts you pay when you actually
receive medical service.
For example, if you are hospitalized, you will be required to pay a deductible amount and you may have to pay
coinsurance amounts, depending on how long you stay. In
2018, the hospital insurance deductible amount is $1,340.
If you receive medical services from a doctor, you pay
a yearly deductible amount as well as a coinsurance amount
for each visit. In 2018, the medical insurance deductible is
$183. After meeting this amount, Medicare generally pays
80 percent of covered services for the rest of the year.
If you cannot afford to pay your Medicare premiums and
other medical costs, States offer programs for low-income
people who are entitled to Medicare. The State-run programs
may pay some or all of Medicare’s premiums and may also
pay Medicare deductibles and coinsurance.
To qualify, you must have Medicare hospital insurance
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(Part A), a limited income, and, in most States, resources,
such as bank accounts, stocks, and bonds, must not be more
than a certain amount. Income limits increase slightly each
year and are higher in Alaska and Hawaii.
To find out if you qualify, contact your State medical
assistance (Medicaid) office. You can get the number for
your State by dialing 1-800-MEDICARE (1-800-633-4227)
and asking for information about the Medicare Savings
Program.

SIGNING UP FOR MEDICARE
If you are already getting railroad retirement or
social security benefits, you will receive information about
the Medicare program a few months before you become
eligible for coverage. At that time, you will automatically
be enrolled in Medicare Parts A and B. However, because
you must pay a premium for Part B coverage, you have the
option of turning it down.
If you are not already getting benefits, you should
contact your local RRB office about 3 months before your
65th birthday to sign up for Medicare. You can sign up for
Medicare even if you don’t plan to retire at age 65.
You should also contact your local RRB office about
applying for Medicare if:
• you are a disabled widow(er) between age 50 and 65
but have not applied for disability benefits because you are
already getting another kind of benefit;
• you had Medicare medical insurance in the past but
dropped the coverage;
• you turned down Medicare medical insurance coverage
when you became entitled to hospital insurance; or
• you, your spouse, or your dependent child has
permanent kidney failure. (Contact a social security office in
these cases to see if you are eligible.)
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Initial Enrollment Period for Medical Insurance
When you first become eligible for hospital insurance
(Part A), you have a 7-month period to sign up for medical
insurance (Part B). This is called your “initial enrollment
period.” A delay on your part may cause a delay in coverage and result in higher premiums. If you are eligible at age
65, your initial enrollment period begins 3 months before
the month of your 65th birthday; includes the month you
turn age 65; and ends 3 months after the month of your 65th
birthday. If you are eligible for Medicare based on disability
or permanent kidney failure, your initial enrollment period
depends on the date your disability or treatment began.
When does your enrollment in Part B become effective? If you accept the automatic enrollment in Medicare
Part B, or if you enroll in Medicare Part B during the
first 3 months of your initial enrollment period, your medical
insurance protection will start with the month you are first
eligible. If you enroll during the last 4 months, your protection will start from 1 to 3 months after you enroll.
If you enroll in this
month of your initial
enrollment period:

Then your
Medicare Part B
coverage starts:
the month you
become eligible for
Medicare

1, 2, 3
4

1 month after
enrollment

5

2 months after
enrollment

6, 7

3 months after
enrollment

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General Enrollment Period for Medical Insurance
If you do not enroll in Medicare Part B during your
initial enrollment period, you have another chance each
year to sign up during a “general enrollment period” from
January 1 through March 31, with coverage effective the
following July 1. However, your monthly premium
increases 10 percent for each 12-month period you were
eligible but did not enroll.
Special Enrollment Period for People Covered
Under a Group Health Plan
If you are age 65 or older and covered under a group
health plan, either from your own or your spouse’s
current employment, you have a “special enrollment
period” in which to sign up for Medicare Part B. This means
that you may delay enrolling in Medicare Part B without
having to wait for a general enrollment period and paying
the 10 percent premium surcharge for late enrollment. The
special enrollment period rules allow you to:
• enroll in Medicare Part B anytime while you are
covered under the group health plan based on current
employment; or
• enroll in Medicare Part B during the 8-month period
that begins the month after your group health coverage ends
or employment ends, whichever comes first.
Special enrollment period rules do not apply if employment or employer-provided group health plan coverage ends
during your initial enrollment period.
If you do not enroll by the end of the 8-month period,
you will have to wait until the next general enrollment
period, which begins January 1 of the next year.

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People who receive disability benefits and are covered
under a group health plan, from either their own or a family
member’s current employment, also have a special enrollment period and premium rights that are similar to those for
workers age 65 or older.
Medigap
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
policies are known as “Medigap” insurance. A Medigap
policy is a health insurance policy, sold by private insurance
companies, that helps pay some of the costs that the Original
Medicare Plan doesn’t cover.
An individual’s enrollment in Medicare Part B at or
after age 65 triggers a one-time “Medigap open enrollment
period.” The open enrollment period lasts 6 months. During
this period, an insurance company cannot deny insurance
coverage, place conditions on a policy, or charge more for a
policy because of past or present health problems.
Individuals age 65 or older with health coverage through
an employer or union based on their or their spouse’s current
employment may want to wait to enroll in Medicare Part B
and delay their Medigap open enrollment period.
More detailed information about Medigap policies and
other supplemental health insurance plans is available in the
publication Medicare & You. To obtain a copy, call the
toll-free number 1-800-MEDICARE (1-800-633-4227) or
go to www.medicare.gov online.

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IF YOU HAVE OTHER
HEALTH INSURANCE
As stated earlier, Medicare hospital insurance (Part A)
is free for almost everyone, but you pay a monthly premium
for Medicare medical insurance (Part B). If you already
have other health insurance when you become eligible for
Medicare, you should ask whether it is worth the monthly
premium cost to sign up for Medicare Part B coverage.
The answer varies with each person and the kind of other
health insurance you may have. Although we cannot give
you “yes” or “no” answers, we can offer a few tips that may
be helpful when you make your decision.
Private Insurance Plans
Contact your insurance agent to see how your private
plan fits with Medicare Part B. This is especially important
if the policy covers other family members. And just as
Medicare does not cover all health services, most private
plans do not either. In planning your health insurance
coverage, also keep in mind that Medicare or private health
insurance policies do not cover most nursing home care.
One important word of caution: for your own protection, do
not cancel any health insurance you now have until your
Medicare coverage actually begins.
Employer-Provided Group Health Plans
Group health plans for employers with 20 or more
employees are required by law to offer workers and their
spouses who are age 65 or older the same health benefits
that are provided to younger employees.
If you currently have coverage under an employerprovided group health plan, you should talk to your human
resources office before you sign up for Medicare Part B.
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Health Care Protection From Other Plans
If you have TRICARE coverage under a program from
the Department of Defense, you must have Medicare
Part B to keep this coverage. However, if you are an activeduty service member, or the spouse or dependent child of
an active-duty service member, you may not have to get
Medicare Part B right away. You can get Part B during a
special enrollment period, and in most cases you won’t pay
a late enrollment penalty. Call the contractor that handles
TRICARE claims at 1-866-773-0404 or a military health
benefits advisor for information before you decide whether
to enroll in Medicare Part B.
If you have health care protection from the Indian Health
Service, Department of Veterans Affairs, or a State medical assistance program, contact those offices to get help on
deciding whether it is to your advantage to have Medicare
Part B coverage.
For more information on how other health insurance
plans work with Medicare, visit www.medicare.gov online
or call 1-800-MEDICARE (1-800-633-4227).

OPTIONS FOR RECEIVING
HEALTH CARE SERVICES
Medicare beneficiaries have choices for receiving health
care services. The Original Medicare Plan is the traditional
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. Those
enrolled in the Original Medicare Plan who want prescription drug coverage must join a Medicare Prescription Drug
Plan as described on pages 13-15, unless they already have
drug coverage from a current or former employer or union
that is at least as good as the standard Medicare prescription
drug coverage.

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A beneficiary can choose a Medicare Advantage
Plan (also called Medicare Part C) instead. These plans
are managed by Medicare-approved private insurance
companies. They combine Medicare Part A and Part B
coverage, and are available in most areas of the country. A
beneficiary must have both Medicare Part A and Part B, and
live in the plan’s service area, to join a Medicare Advantage
Plan. 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).
Beneficiaries can generally join or change plans once
each year during an enrollment period from October 15
through December 7. Your Medicare Advantage Plan would
then begin January 1 of the following year. Also, the monthly Part C premium can be deducted from railroad retirement
or social security benefits paid by the RRB if the beneficiary
submits a request for withholding to his or her Part C plan.
You can obtain more information about your health care
options from the publication Medicare & You. This general
guide is mailed after enrollment in Medicare, with an updated version mailed annually thereafter.
To obtain a copy of any publication, call the Medicare
toll-free number 1-800-MEDICARE (1-800-633-4227) or
go to www.medicare.gov online.
Some publications may instruct you to call or visit an
office of the SSA for assistance. Railroad retirement beneficiaries should instead contact an RRB office.

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MEDICAL INSURANCE CLAIMS
Palmetto GBA, a subsidiary of Blue Cross and Blue
Shield, processes medical insurance (Part B) claims for
railroad retirement beneficiaries in the Original Medicare
Plan. If you are in the Original Medicare Plan, your hospital,
doctor, or other health care provider should submit Part B
claims directly to:
Palmetto GBA
Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001
If you have questions about Part B claims under the
Original Medicare Plan, write to Palmetto GBA at the above
address or call toll-free at 1-800-833-4455. Information is
online at www.palmettogba.com/medicare by clicking on
“RRB Specialty MAC Beneficiaries.”
For those in a Medicare Advantage Plan, information
on out-of-pocket costs is available at www.medicare.gov
online or by calling 1-800-MEDICARE (1-800-633-4227).

PRESCRIPTION DRUG COVERAGE
Medicare offers voluntary insurance coverage for
prescription drugs (Part D) through Medicare prescription
drug plans and other health plan options. While Medicare
prescription drug plans vary, all drug plans offer coverage
that, at the very least, meets a minimum standard of
coverage as determined by Medicare. These drug plans
work with all Medicare health plans, including the Original
Medicare Plan and Medicare Advantage Plans.

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To enroll, you must have Medicare Part A and live in
the plan’s service area. You will generally pay a monthly
premium (averaging about $35 in 2018) and an annual
deductible (up to $405 in 2018). You must also pay a share
of your prescription drug costs. Costs vary depending on
the drug plan you choose. If you have limited income and
resources, you may qualify for extra help to cover your drug
costs.
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 2018 are $13.00, $33.60, $54.20,
or $74.80, depending on the extent to which an individual
beneficiary’s modified adjusted gross income exceeds
$85,000 (or $170,000 for a married couple), with the highest
amounts only paid by beneficiaries whose incomes are over
$160,000 (or $320,000 for a married couple).
When you first become eligible for Medicare, you
can enroll in a Medicare prescription drug plan during the
period that starts 3 months before the month your Medicare
coverage starts and ends 3 months after that month. If you
do not join a drug plan when you are first eligible, you
may have to pay a higher premium if you choose to join
later.
A beneficiary can generally join or change plans once
each year during an enrollment period from October 15
through December 7. Drug coverage would then begin
January 1 of the following year. Also, the monthly Part D
premium can be deducted from railroad retirement or social
security benefits paid by the RRB if the beneficiary submits
a request for withholding to his or her Part D plan. The RRB
also withholds Part D income-related adjustments from
benefit payments.

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If you already have prescription drug coverage from
other insurance, such as coverage provided by an employer
or union, you can keep that coverage. If that coverage offers
the same or better benefits than a Medicare prescription drug
plan, you will not have to pay a higher premium if you join
a Medicare prescription drug plan at a later date. In many
cases, your other insurance provider will send you a notice
that tells you if your plan covers as much or more than a
Medicare prescription drug plan. If you do not receive a
notice, you should check with your other provider to see
how your coverage compares.
More information about Medicare prescription drug
plans is available online at www.medicare.gov or by calling
1-800-MEDICARE (1-800-633-4227).
Need More Information?
Railroad retirement beneficiaries should contact the
RRB toll-free at 1-877-772-5772 for general information on
their Medicare coverage. They can also visit the agency’s
website at www.rrb.gov, or the Medicare and Palmetto GBA
information sources as described on the back cover and
elsewhere in this booklet.

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NONDISCRIMINATION ON THE
BASIS OF DISABILITY
Under Section 504 of the Rehabilitation Act of 1973 and
RRB regulations, no qualified person may be discriminated
against on the basis of disability. The RRB’s programs and
activities must be accessible to all qualified applicants and
beneficiaries, including those with impaired vision and/or
hearing. Individuals with disabilities needing assistance
(including auxiliary aids or program information in
accessible formats) should contact an RRB office.
Complaints of alleged discrimination by the RRB on
the basis of disability must be filed within 90 days in
writing with the Director of Administration, U.S. Railroad
Retirement Board, 844 North Rush Street, Chicago, Illinois
60611-1275. Questions about individual rights under this
regulation may be directed to the RRB’s Director of Equal
Opportunity at the same address.

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FRAUD, WASTE AND ABUSE HOTLINE
1-800-772-4258
The RRB’s Office of Inspector General established its
Hotline as a public service. The Hotline provides individuals
with a means to report or discuss any suspected misconduct
relating to the RRB, its programs or employees.
If you believe a doctor, hospital or other health care
provider is billing Medicare for services not provided or
for unnecessary medical procedures or supplies; someone
is illegally receiving RRB benefits; or you wish to report or
discuss any other suspected misconduct relating to the RRB,
its programs or employees, please contact the Office of
Inspector General at:
Toll-Free Hotline: 1-800-772-4258
U.S. Mail:
RRB-OIG Hotline Officer
844 North Rush Street, 4th Floor
Chicago, IL 60611-1275
Fax: (312) 751-4342
E-mail: [email protected]
Please review the RRB’s e-mail notice and Internet privacy policy at www.rrb.gov before submitting information
online.
Note: Please do not contact the Office of Inspector
General’s Hotline with questions regarding benefit eligibility requirements, delayed payments or similar issues. These
types of matters should be directed to an RRB office.

U.S. Railroad Retirement Board
Toll-Free Service and Website
1-877-772-5772
www.rrb.gov
The RRB’s toll-free telephone service provides customers with
easy access to agency representatives. In addition, through automated
menus available 24 hours a day, you can find the address for the RRB
office serving your area and listen to special announcements about
the agency’s benefit programs. You can also request a replacement
Medicare card, a letter showing your current monthly benefit rate, a
replacement tax statement for the most recently completed tax year,
or a statement of creditable railroad service and compensation. Information on unemployment-sickness claims is also available.
Most of these services and others, including annuity estimates
and online filing of unemployment applications and claims, as well
as sickness claims, are available on the RRB’s website. The website
also offers access to agency publications and information about many
topics of interest.
Medicare Toll-Free Number and Website
1-800-MEDICARE (1-800-633-4227)
TTY/TDD 1-877-486-2048
www.medicare.gov

To get help with your Medicare questions, you can call Medicare’s toll-free number or look on the website.
Palmetto GBA Toll-Free Number and Website
1-800-833-4455
TTY/TDD 1-877-566-3572
www.palmettogba.com/medicare

If you are in the Original Medicare Plan and have questions
about Medicare medical insurance (Part B) claims, you can call
Palmetto GBA’s toll-free number or visit the website for help.
U.S. Railroad Retirement Board
844 North Rush Street
Chicago, Illinois 60611-1275

Form RB-20

January 2018