This booklet is issued for the purpose of
general information. Certain limitations, exceptions and special cases are not
covered.
It is presented to you section by section as it appears in print.
You may page through the publication by using the
links on the left.
Why You Should Read This Booklet
Railroad workers are covered under the Medicare program just like workers
covered under social security. Railroad retirement payroll taxes include a
Medicare hospital insurance tax just like social security payroll taxes.
Even 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 be aware of
what benefits the program offers. The basic information in this publication will
give you an overview of the Medicare program.
More detailed information on Medicare's benefits, costs, and health service
options is available from the Centers for Medicare & Medicaid Services
publication "Medicare & You" which is mailed to Medicare beneficiary households
each fall and to new Medicare beneficiaries when they become eligible for the
coverage. "Medicare & You" and other Medicare publications are also available by
phone or online:
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
At the website select, “Find
a Medicare Publication”, under Search Tools.
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.
Medicare is financed by a portion of railroad retirement tier I and social
security payroll taxes paid by employees and employers. It is also financed in
part by monthly premiums paid by enrollees.
The Centers for Medicare & Medicaid Services (CMS) is the agency in charge of
the Medicare program. The Railroad Retirement Board, however, 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,
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, outpatient hospital
services, blood and preventive services, among others.
- Prescription Drug Coverage
(also called Medicare Part D),
as described in more detail under
"Medicare Prescription Drug Plans".
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 little or no
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.
If you are entitled to monthly benefits based on an occupational disability,
and have been granted a disability
freeze, you are eligible for Medicare 29 months after the
freeze date. 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 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 or widower, 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 widows and widowers under age 65, disabled surviving divorced
spouses under age 65, and disabled children may be eligible for Medicare,
usually after a 24-month qualifying 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 who is eligible for free Medicare hospital insurance (Part A) can enroll
in Medicare medical insurance (Part B) by paying a monthly premium. While most
people pay the basic monthly premium ($96.40 in 2008), 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 2008 are $122.20, $160.90, $199.70, or
$238.40, depending on the extent to which an individual beneficiary’s income
exceeds $82,000 (or a married couple’s income exceeds $164,000), with the
highest premium rates only paid by beneficiaries whose incomes are over $205,000
(or $410,000 for a married couple). The income thresholds increase annually by
indexing to the Consumer Price Index (CPI).
The Social Security Administration (SSA) is responsible for all
income-related monthly adjustment amount determinations. To make the
determinations, SSA uses the most recent tax return information provided by the
IRS. For 2008, in most cases that is the beneficiary’s 2006 tax return
information. If that information is not available, SSA uses information from the
2005 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 may have to pay coinsurance amounts, depending on how long you stay.
In 2008, the hospital insurance deductible amount is $1,024.
If you receive medical services from a doctor, you pay a yearly deductible
amount as well as a coinsurance amount for each visit. In 2008, the medical
insurance deductible is $135.
If you cannot afford to pay your Medicare premiums and other medical costs, you
may be able to get help from your State. States offer programs for people who
are entitled to Medicare and have low income. 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 Part A (hospital insurance), a limited
income, and, in most States, your 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 to call in 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’re already getting railroad
retirement or social security benefits, you will be contacted a few
months before you become eligible for Medicare and given information about the
Medicare program. 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 aren’t already getting benefits,
you should contact your local Railroad Retirement Board 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 Board office about applying for Medicare if:
- you’re a disabled widow or widower between age 50 and age 65 but haven’t
applied for disability benefits because you’re already getting another kind of
benefit;
- you had Medicare medical insurance in the past but dropped the coverage;
- you turned down Medicare medical insurance 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.)
Initial Enrollment Period for Part B
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 your 65th birthday, includes the month
you turn age 65, and ends 3 months after that 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 my 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:
|
1, 2, 3 |
the month you become eligible for Medicare |
4 |
1 month after enrollment |
5 |
2 months after enrollment |
6, 7 |
3 months after enrollment |
General Enrollment Period for Part B
If you don’t 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. Your coverage begins the following
July. However, your monthly premium
increases 10 percent for each 12-month period you were eligible but didn’t
enroll.
Special Enrollment Period for People Covered
Under a Group Health Plan
If you are age 65 or older and are 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 rules allow you to:
- enroll in Medicare Part B any time 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 with the
month your group health coverage ends, or the month 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.
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 for
some of the costs that the Original Medicare Plan doesn’t pay for.
When an individual enrolls in Medicare Part B at or after age 65, a one-time
“Medigap open enrollment period” is triggered. The open enrollment period lasts
for 6 months. During this period, an insurance company can’t 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 "Choosing a Medigap Policy: A
Guide to Health Insurance for People with Medicare." To get a copy by phone or
online:
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
At the website select, “Find
a Medicare Publication”, under Search Tools.
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 is it worth the monthly premium cost to sign up
for Medicare medical insurance.
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
medical insurance. This is especially important if you have family members who
are covered under the same policy. And remember, just as Medicare does not cover
all health services, most private plans do not either. In planning your health
insurance coverage, keep in mind that most nursing home care is not covered by
Medicare or private health insurance policies. 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 of 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 are currently covered under an employer-provided group health plan, you
should talk to your personnel office before you sign up for Medicare medical
insurance.
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 active
duty 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 medical insurance.
If you have health care protection from the Indian Health Service, Department of
Veterans Affairs or a State medical assistance program, contact the people in
those offices to help you decide whether it is to your advantage to have
Medicare medical insurance.
For more information on how other health insurance plans work with Medicare, get
the guide, "Medicare and Other Health Benefits: Your Guide to Who Pays First" by
phone or online:
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
At the website select, “Find
a Medicare Publication”, under Search Tools.
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. Persons enrolled in the Original Medicare Plan who want
prescription drug coverage must join a Medicare Prescription Drug Plan as
described under "Medicare Prescription
Drug Plans", 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.
Or a beneficiary can choose a
Medicare Advantage Plan (also
called Medicare Part C). These plans
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 to join a Medicare Advantage Plan, and the individual
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).
You can get more information about your health care options from the publication
"Medicare & You." This general guide is mailed to people after they enroll in
Medicare and an updated version is mailed each year after that.
To get a copy of this, or any other publication by phone or online:
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
At the website select, “Find
a Medicare Publication”, under Search Tools.
Some publications may instruct you to call or visit an office of the Social
Security Administration for assistance. Railroad retirement beneficiaries should
contact the nearest Railroad Retirement Board office.
Medical
Insurance Claims
Palmetto GBA, a subsidiary of Blue Cross and Blue Shield of
South Carolina, 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
1-800-833-4455
|
If you have questions about Part B claims under the Original
Medicare Plan, write to Palmetto GBA at the above address; or by phone or
online:
At the website click on "Railroad Medicare" under "People with Medicare," and select, “Contact
Us”.
For those in a Medicare Advantage Plan, information on out-of-pocket costs is
available by phone or online:
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
At the website select, “Compare
Health Plans and Medigap Policies in Your Area”, under Search Tools.
Medicare Prescription Drug Plans
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.
To enroll, you must have Medicare Part A and/or Part B. You will generally pay a
monthly premium (about $25 in 2008) and an annual deductible (up to
$275 in 2008). 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.
When persons first become eligible for Medicare, they can enroll in a Medicare
prescription drug plan during the period that starts 3 months before the month
their Medicare coverage starts and ends 3 months after that month.
If you don't join a drug plan when you are first eligible, you may have to pay a
higher premium if you choose to join later.
Beneficiaries can generally join or change plans once each year during an "open
enrollment period" from November 15 through December 31. Drug coverage would
then begin January 1 of the following year.
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 in the
publication "Your Guide to Medicare Prescription Drug Coverage." "The
Medicare & You " handbook lists the Medicare prescription drug plans that
are available in your area. You can get either publication by phone or online:
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
At the website select, “Find
a Medicare Publication”, under Search Tools.
Need
More Information?
Railroad retirement beneficiaries should contact the nearest Railroad
Retirement Board office for general information on their Medicare coverage.
They can also use the Board's automated toll-free number and Web site, or the
Medicare and Palmetto GBA information sources below.
Medicare Toll-Free Number and Web Site
Toll Free: |
1-800-MEDICARE
(1-800-633-4227) |
TTY/TDD: |
1-877-486-2048 |
Website: |
www.medicare.gov |
|
To get help with your Medicare questions, you can call Medicare's toll-free number or look on the Web site.
Palmetto GBA Toll-Free Number and Web Site
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 their Web site for help.
###
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