Explaining Railroad Medicare: benefits, eligibility, and more

Railroad workers have been receiving Medicare benefits since 1975. But there is still confusion around the program.

Medicare is a government-sponsored health insurance program. It provides coverage to individuals who are aged 65 and older. And for those who have certain disabilities or end-stage renal disease. Railroad Medicare, on the other hand, is a federal health insurance program tailored for railroad workers, retirees, and their dependents.

What is the Railroad Medicare?

Railroad Medicare is a specific type of Medicare coverage that is available to current and former railroad workers and their families. The Centers for Medicare & Medicaid Services (CMS) runs the program. But the Railroad Retirement Board (RRB) is in charge of deciding who is eligible and giving out benefits for Railroad Medicare. It covers the same services as Original Medicare.

Is Railroad Medicare the same as Original Medicare?

Railroad Medicare functions similarly to Original Medicare. It provides coverage for hospital stays (Part A) and medical services (Part B). It also offers options for additional coverage through Medicare Advantage plans (Part C) and prescription drug coverage (Part D).

However, there are a few key differences between the two programs. One of the biggest differences is how benefits are administered. Railroad Medicare is administered by the RRB. This means individuals must contact the RRB to enroll and receive benefits. In contrast, Original Medicare is administered by CMS. Individuals enroll through the Social Security Administration (SSA) or online.

Another difference between railroad Medicare and Original Medicare is the cost of coverage. Railroad Medicare enrollees are responsible for paying the same premiums, deductibles, and coinsurance as those on Original Medicare. However, the RRB may offer additional financial assistance to help offset these costs for eligible individuals.

Is Railroad Medicare better than Original Medicare?

Railroad Medicare provides the same benefits as Original Medicare. But with a few additional perks. For example, Railroad Medicare covers the cost of medical services for both the member and their spouse. Even if the spouse did not work for the railroad industry. And, if a member of Railroad Medicare has a disability that prevents them from working, they may be eligible for Medicare benefits regardless of their age.

Railroad Medicare eligibility

To be eligible for Railroad Medicare, a person must meet one of the following requirements.

1. Be age 65 or older and receive or are eligible for railroad retirement.
2. Disabled employees who have been receiving total disability payments for at least 24 months are eligible for coverage prior to age 65. Those with ALS, widely known as Lou Gehrig’s disease, do not need to wait 24 months before receiving coverage.
3. Have at least 10 years of experience working in the railroad industry as a current or former railroad employee.
4. The spouse or widow(er) of a current or former railroad worker who meets the above criteria.
5. The child or disabled adult child of a current or former railroad worker who meets the above criteria.

Enrollment Process

The enrollment process for Railroad Medicare follows similar guidelines as Original Medicare.

Initial Enrollment Period (IEP)

Most individuals are automatically enrolled in Railroad Medicare when they become eligible for Railroad Retirement benefits. They receive a Welcome to Medicare package. And contains the member’s Railroad Medicare payer ID and Railroad Medicare card a few months before turning 65.

A person not yet receiving retirement benefits, is not enrolled automatically. In this case, they need to sign up for Railroad Medicare by contacting their local RRB office.

Special Enrollment Period (SEP)

Certain circumstances, such as loss of employer coverage or relocation, may trigger a Special Enrollment Period. It allows individuals to enroll in Railroad Medicare outside of the Initial Enrollment Period.

General Enrollment Period (GEP)

Individuals who missed their Initial Enrollment Period can enroll during the General Enrollment Period. It runs each year from January 1 to March 31. Coverage is effective the month after enrollment. (The monthly premium increases 10 percent for each 12-month period a person is eligible to enroll but didn’t.)

Conclusion

Railroad Medicare is a unique version of Original Medicare. It’s only available to current and former railroad workers and their families. While it covers the same services as Original Medicare, there are a few key differences. Enrollment is processed through the RRB instead of by Social Security. Doctors and other providers must send Railroad Medicare Part B claims to the Part B contractor selected by RRB. Providers must know when an individual has Railroad Medicare to ensure Medicare pays in a timely manner. The Railroad Medicare card looks a little different and includes Railroad Retirement Board on the bottom of it. If you’re a current or former railroad worker, or the spouse or dependent of one, you may want to consider enrolling in Railroad Medicare. Contact a RRB agency representative by calling 1-877-772-5772 (TTY: 711). They can provide information regarding your options and how to enroll.