8 Essential Questions about Railroad Retirement Medicare

Discover Railroad Retirement Medicare in 2024, akin to Social Security and Medicare, covering railway workers and their families. Delve into eligibility, costs, enrollment, and coverage options for comprehensive overview of Railroad Retirement Medicare.

1. What is Railroad Retirement Medicare?

What is Medicare?
Medicare covers railway workers aged 65+, disabled individuals, and those with permanent kidney failure. Railroad retirement and Medicare works similar to Social Security and Medicare.

Medicare Includes:

• Hospital Insurance (Part A): Inpatient care, skilled nursing facilities, home health care, hospice.
• Medical Insurance (Part B): Doctor services, medical supplies, preventive services.
• Medicare Advantage Plans (Part C): Managed by private insurers, combining Part A and Part B coverage.
• Prescription Drug Coverage (Part D): Optional coverage for prescription drugs.

2. How to qualify for Railroad Retirement Medicare?

Hospital Insurance (Part A)

Age 65 or Older and you are citizens or permanent residents of the United States:

Eligible for free Medicare Part A. Automatically eligible for Medicare at age 65 with railroad retirement or social security benefits. Even if your full retirement age is 67.

Under Age 65:

Eligible if entitled to monthly benefits based on total disability for at least 24 months. Occupational disability and disability freeze also grant eligibility.

Eligible with Lou Gehrig’s disease (amyotrophic lateral sclerosis).

Family Members Age 65 or Older:

Spouse, divorced spouse, surviving divorced spouse, widow(er), or dependent parent may qualify.

Family Members Under Age 65:

Disabled widowers, surviving divorced spouses, and children eligible after 24-month waiting period.

Permanent Kidney Failure:

Eligible at any age if receiving maintenance dialysis or kidney transplant. Family members may also qualify based on your eligibility and condition regarding permanent kidney.

3. Understanding Railroad Retirement Medicare Medical Insurance (Part B)

Eligibility:

Anyone eligible for free Medicare hospital insurance can enroll in Part B. Monthly premium required, with standard premium rate of $174.70 in 2024.

The 2023 premium amount was just about $10 less than the 2024 $174.70 standard premium.

Income-Related Premiums for beneficiaries:

Premiums for beneficiaries vary based on modified adjusted gross income.

The income-related Part B premiums for 2024 are :

$244.60,

$349.40,

$454.20,

$559.00,

or $594.00,

The part B premium is depended on how much a beneficiary’s adjusted gross income exceeds $103,000 (or $206,000 for a married couple). 

The Social Security Administration Determines Premiums:

• Social Security Administration uses IRS tax return information.
• 2023 tax return used for most cases; 2022 used if 2023 not available.
• If the beneficiaries has higher income then they will pay higher premiums.

4. What is Railroad Retirement Medicare Costs?

Monthly Premiums:

Vary based on income, with standard premium rate of $174.70 in 2024 for the Railroad employee.

Out-of-Pocket Costs:

• Include deductibles and coinsurance for medical services.
• Hospital insurance deductible: $1,632 in 2024.
• Medical insurance deductible: $240 in 2024. Once you meet this deductible Medicare pays 80% of the covered services for the rest of that plan year, and you are responsible for the remaining 20%.

Coverage:

• Medicare generally pays 80% of covered services after meeting deductible.

Financial Assistance:

• Low-income individuals may qualify for State-run programs.
• Programs may cover premiums, deductibles, and coinsurance.
• Contact State Medicaid office or dial 1-800-MEDICARE for information.

5. How To Sign Up for Medicare?

Automatic Enrollment:

If receiving railroad retirement or social security benefits, you are enrolled in Parts A and B automatically.

You are given the option to decline Part B coverage.

Initial Enrollment Period:

Begins 3 months before 65th birthday. Enrollment period extends 3 months after 65th birthday month.

If you delay your enrollment you may result in higher premiums. Coverage effective from month of eligibility or following month if enrolled late.

General Enrollment Period:

Starts January 1 of each year. Coverage effective month after enrollment.

Premium increases by 10% for each 12-month delay.

Special Enrollment Period:

For those covered under group health plan during their Medicare eligibility time frame. Enrollment anytime during coverage or 8 months after coverage ends.

Rules vary for disability beneficiaries.

Medigap Considerations:

Enrollment in Part B triggers Medigap open enrollment period (6 months). During this period, insurance companies cannot deny coverage or charge more due to health conditions.

More details available in Medicare & You publication or through 1-800-MEDICARE.

6. What If You Have Other Health Insurance; outside of Railroad Retirement Medicare

Private Insurance Plans:

It’s important to assess compatibility with Medicare Part B, and a private health insurance plan. Consider coverage for family members.

Note limitations on services covered, including nursing home care. Don’t cancel existing coverage until Medicare begins.

Employer-Provided Group Health Plans:

Employers with 20+ employees must offer comparable benefits to 65 and over as to those under 65. Consult HR before enrolling in Medicare Part B.

Health Care Protection from Other Plans:

TRICARE: Requires Medicare Part B for coverage. Active-duty service members or dependents may delay enrollment.

Inquire about special enrollment periods and penalties.

Indian Health Service, Department of Veterans Affairs, or State medical assistance program are available for advice on Medicare Part B enrollment. It’s important, to consider impact on existing coverage.

7. What Are your Options for Receiving Health Care Services?

Original Medicare Plan:

• Traditional fee-for-service Medicare that is available Nationwide.
• Choose any Medicare-accepting doctor or provider.
• Enroll in a separate Medicare Prescription Drug Plan for drug coverage.

Medicare Advantage Plan (Medicare Part C):

• Managed by Medicare-approved private insurance companies.
• Combines Part A and Part B coverage.
• Available in most areas.
• Requires both Part A and Part B enrollment.
• Choices include PPOs, HMOs, private fee-for-service plans, and more.
• May offer lower copayments, extra benefits, and prescription drug coverage.
• Enrollment or plan changes annually from October 15 through December 7.
• Monthly premiums can be deducted from railroad retirement or social security benefits.

8. What are the Medicare Part D, details?

Medicare Part D:

Voluntary insurance for prescription drugs. Offered through Medicare prescription drug plans and other health plan options.

Medicare Part D is available with all Medicare health plans, including Original Medicare and Medicare Advantage Plans. Requires Medicare Part A enrollment and residence in the plan’s service area.

Monthly premium (averaging about $34.70 in 2024) and annual deductible (up to $545 in 2024). Additional costs based on prescription drug plan choice.

Some beneficiaries may qualify for extra help based on limited income and resources. Affordable Care Act may impose monthly adjustment amounts based on modified adjusted gross income.

Initial enrollment period starts 3 months before Medicare coverage begins and ends 3 months after. Annual enrollment period from October 15 through December 7 for plan changes.

Monthly premiums and income-related adjustments can be withheld from railroad retirement or social security benefits.

Existing prescription drug coverage from other sources may be maintained without facing higher premiums if coverage meets or exceeds Medicare standards.

Conclusion

Navigating Railroad Retirement Medicare is crucial for railway workers and their beneficiaries. From understanding eligibility criteria to exploring coverage options, empower yourself with the knowledge to make informed healthcare decisions for a secure future.

My railroad retirement is here, as you pull the pin and highball to retirement.