FOM1 720 Medicare For SS Beneficiaries Revised June 15, 2023 Page 1 of 2

FOM1 720 

720.5 Jurisdiction 

The RRB assumes Medicare jurisdiction for all persons whose SS benefits are certified 

to the RRB for payment. This includes people who would not be considered qualified 

railroad retirement beneficiaries (QRRBs). These beneficiaries are "deemed" QRRBs 

for Medicare purposes. 

720.10 RRB Responsibilities 

The RRB is responsible for setting up a Health Insurance (HI) record, issuing the 

Medicare ID card and collecting supplementary medical insurance (SMI) premiums from 

beneficiaries whose SS benefits are paid by the RRB. Palmetto GBA will process the 

Part B Medicare claims. 

720.15 SMI Premium Collection 

720.15.1 Social Security Entitlement Only 

A. SS benefit payable - SMI premiums will be deducted from the monthly benefit 

payable unless the rate is lower than the premium amount. If the monthly SS 

rate is lower than the premium amount, the beneficiary will be billed directly for 

the SMI premiums by the RRB. 

B. SS benefit not payable due to work deductions, etc., for an indefinite period of

time - SMI premiums will be collected by the RRB through direct billing. 

C. SS benefit not payable for a short time (e.g., for recovery of an overpayment) -

SMI premiums will be deducted at the time of reinstatement. 

720.15.2 Combined Railroad and Social Security Entitlement 

If a beneficiary is receiving a combined RR/SS benefit, the premiums will always be 

deducted from the RR portion due to current processing limitations. If the RR portion is 

lower than the premium amount, the beneficiary will be billed directly for the premiums, 

even though the SS benefit is large enough for premium deductions. 

720.15.3 Combined RR/SS Entitlement - RR Rate Equals Zero 

If an RR annuity rate equals zero due to reductions in tier I for SS benefits, worker's 

compensation, etc., the SMI premiums will be collected as follows: 

A. RR annuity in suspense - The annuitant will be billed directly for SMI premiums. 

B. RR annuity terminated or constructive award made - SMI premiums will be 

deducted from the SS benefit. 
FOM1 720 Medicare For SS Beneficiaries Revised June 15, 2023 Page 2 of 2

720.20 SMI Premium Arrearages 

SMI premium arrearages occur when premiums are due but unpaid for months in which 

the railroad annuity or SS benefit has not been paid. 

Sometimes the RRB receives an SS benefit from the Social Security Administration 

(SSA) with a Medicare entitlement date that is in the past. This happens frequently in 

disability cases. When this occurs, past premiums must be deducted from the benefits 

payable. 

720.20.1 Entitlement to Social Security Benefits Only 

A. Premium arrearage less than 6 months or 50% of benefit accrual - The entire 

arrearage will be deducted from the SS accrual. The award notice released by 

the RRB will explain the amount of the premiums deducted and the months for 

which they are due. 

B. Premium arrearage more than 6 months or 50% of benefit accrual - Medicare 

coverage and premium deductions will be effective with the month of examiner 

handling. The enrollee will be notified of the start of premium deductions but not 

the retroactive premiums. Medicare examiners will determine if the equitable 

relief provisions apply and will implement recovery for the premium arrearage. 

If the beneficiary is offered equitable relief but subsequently asks for waiver or 

protests the arrearage amount, the Medicare Unit will determine the validity of 

the arrearage amount and notify the beneficiary. In addition, they will forward the 

waiver request to the Bureau of Fiscal Operations’ Debt Recovery Section’s 

group mailbox, BFODebtRecoveryWaiverGroup@rrb.gov, to determine waiver 

eligibility. 

If the equitable relief provisions do not apply, Medicare coverage will remain 

effective with the month of examiner handling. 

720.20.2 Entitlement to Railroad and Social Security Benefits 

The premium arrearage will be recovered from the railroad annuity according to current 

instructions. 

720.25 Transfers of Medicare Jurisdiction 

Whenever the SS payment jurisdiction changes from RRB to the Social Security 

Administration (SSA), Medicare jurisdiction will also be transferred for entitled 

beneficiaries. Headquarters will transfer the benefit and Medicare jurisdiction at the 

same time and will advise SSA of the paid-through dates. Also, see FOMI 705.50.