U.S. Railroad Retirement Board

MEDICARE

for Railroad Workers and Their Families

RRB.gov

2024
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 retirement 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? .................................................... 2

Who can get Medicare? ............................................ 3

How much does Medicare cost?................................. 5

Signing up for Medicare ........................................... 6 

If you have other health insurance ............................ 9

Options for receiving health care services ................ 11

Medical insurance claims ......................................... 13

Prescription drug coverage ....................................... 13

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 Medicare.gov or by 

calling toll-free 1-800-MEDICARE (1-800-633-4227),

TTY/TDD 1-877-486-2048.

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This booklet is for general information.

It does not cover certain limitations,

exceptions and special cases.
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 annuity 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 pages 11 and 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 a railroad retirement annuity or social security 

benefits. (Although the age requirements for some 

unreduced railroad retirement annuities have risen just like 

the social security requirements, individuals 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 annuity payments based on total disability for at least 24 months and have a disability insured status 

under social security law. If you are entitled to monthly 

annuity payments based on 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 payments. If you receive an annuity 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

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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 a railroad retirement annuity or 

social security benefits.

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 $174.70 in 2024. This is about $10 more than 

the 2023 premium amount.

Monthly premiums for some beneficiaries are greater, 

depending on their modified adjusted gross income. The 

income-related Part B premiums for 2024 are $244.60, 

$349.40, $454.20, $559.00, or $594.00, depending on how

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much a beneficiary’s adjusted gross income exceeds

$103,000 (or $206,000 for a married couple). Beneficiaries 

whose modified adjusted gross income exceeds $500,000 

(or $750,000 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 2024, in most cases 

that is the beneficiary’s 2022 tax return. If that is not 

available, SSA uses information from the 2021 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 

2024, the hospital insurance deductible amount is $1,632.

If you receive medical services from a doctor, you pay a 

yearly deductible amount as well as a coinsurance amount 

for each visit. In 2024, the medical insurance deductible is 

$240. 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 

(Part A), a limited income, and, in most states, resources, 

such as bank accounts, stocks, and bonds, must not be more

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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 a railroad retirement

annuity 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 annuity or benefit

payments, you should contact your local RRB office about 

3 months before your 65th birthday to enroll in 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 had Medicare medical insurance in the past but

dropped the coverage; or

• you turned down Medicare medical insurance coverage

when you became entitled to hospital insurance.

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. SSA has jurisdiction of Medicare in these

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• you are a disabled widow(er) between age 50 and 65

but have not applied for an annuity because you are 

already getting another kind of benefit;
cases; consquently, an SSA office should be contacted for 

information on coverage for kidney disease.

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 will start with the month you are first eligible. If 

you enroll during the last 4 months, your coverage will start 

from the first day of the following month.

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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, 5, 6, 7 month after

enrollment

General Enrollment Period for Medical Insurance

 If you do not enroll in Medicare Part B during your initial 

enrollment period, you have another chance during a General 

Enrollment Period from January 1 through March 31, with 

coverage effective the month after you enroll in Part B.
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 pay the 10 percent premium surcharge for late enrollment. The Special 

Enrollment Period rules allow you to:

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.

People who receive disability annuities 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.

In addition, an individual may be eligible for a Special 

Enrollment Period if they missed an enrollment period

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• enroll in Medicare Part B anytime while you are
because of certain exceptional circumstances. More details 

can be found in the Medicare & You publication or on 

Medicare.gov.

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 tollfree number 1-800-MEDICARE (1-800-633-4227) or go to 

Medicare.gov online.

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.

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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.

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.

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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 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.

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

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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 

annuities 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 Medicare.gov online.

Some publications may instruct you to call or visit an 

SSA office 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 Palmettogba.com/palmetto/rrb.nsf.

For those in a Medicare Advantage Plan, information on 

out-of-pocket costs is available at 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.

13
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 $34.70 in 2024) and an annual 

deductible (up to $545 in 2024). 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 2024 are $12.90, $33.30, $53.80, 

$74.20, or $81.00, depending on the extent to which an 

individual beneficiary’s modified adjusted gross income 

exceeds $103,000 (or $206,000 for a married couple), with 

the highest amounts only paid by beneficiaries whose 

incomes are over $500,000 (or $750,000 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 annuities 

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 monthly annuity payments.

14
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 Medicare.gov or by calling 

1-800-MEDICARE (1-800-633-4227).

Need More Information?

Railroad retirement beneficiaries can visit the agency’s 

website at RRB.gov, or the Medicare and Palmetto GBA 

information sources as described on the back cover and 

elsewhere in this booklet. They can also contact the RRB 

toll-free at 1-877-772-5772 for general information on their 

Medicare coverage.

15
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 Office of Equal Opportunity, 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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Toll-Free Hotline: 1-800-772-4258

Mailing address: RRB-OIG Hotline Officer

 844 North Rush Street, 4th Floor 

 Chicago, Illinois 60611-1275 

Fax: (312) 751-4342 

Email: hotline@oig.rrb.gov 

Please review the RRB’s email notice and Internet 

privacy policy at RRB.gov before submitting any 

information online. 

Note: Please do not contact the OIG’s Hotline with questions 

regarding benefit eligibility requirements, delayed payments, 

or similar issues. These types of matters should be directed to 

any RRB field office.

FRAUD, WASTE, AND ABUSE HOTLINE

1-800-772-4258

The RRB’s Office of Inspector General (OIG) established 

its Hotline as a public service. The Hotline provides individu als 

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 OIG at: 
U.S. Railroad Retirement Board

Toll-Free Service and Website

1-877-772-5772

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

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

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 2024