If you aren’t familiar with Railroad Medicare insurance, it is a health coverage plan that is almost exactly what it sounds like; a form of Medicare coverage for retired rail workers and certain members of their family. Coverage includes the normal Medicare programs like Part A for hospital care, Part B for medical care, Part D for prescription coverage, etc. The Railroad Retirement Board (RRB) and their contractor, Palmetto GBA, administer Railroad Medicare separately from traditional Medicare.
The RRB was established in the 1930s to create retirement plans for the nation’s railroad workers. At that time, the rail industry was ahead of others in creating pension plans for its employees. When Congress created Social Security following the Great Depression, rail workers believed their existing safety net was sufficient and sought to keep the RRB separate from what would become the Social Security program. Consequently, the Railroad version of Medicare coverage was developed.
The Railroad Medicare, RR Medicare, insurance benefits are the same as other Medicare programs. This includes hospital coverage under Medicare Part A and medical insurance under Medicare Part B. Railroad beneficiaries are also eligible for enrollment in supplemental Medigap plans, as well Medicare Advantage plans (Part C) and prescription drug plans under Medicare Part D.
As with other Medicare programs, Medicare’s railroad coverage starts at 65, regardless of the age requirements for other Railroad retirement benefits to start. The exception to this age limit is for individuals who qualify before the age of 65 for disability coverage.
Railroad Medicare insurance benefits are equivalent to those of other Medicare programs, including:
Railroad Medicare eligibility is open to any railroad workers who have completed at least 10 years of “covered” service in the railroad industry. Covered service means that during those years of work, you were paying Railroad taxes instead of the Social Security taxes that most workers pay. The 10-year requirement is reduced to 5 years if those years were completed after 1995. Spouses of workers who qualify for railroad benefits also qualify for the same medical benefits, including Railroad-specific Medicare coverage.
Your Provider Transaction Access Number is a unique number assigned to each provider to allow them to bill Medicare on behalf of their patients. Your PTAN is attached to any claims you submit to Railroad Medicare for reimbursement. It is a number that identifies you as a qualified and enrolled provider for Medicare patients who fall under the Railroad coverage.
Even if you already have a PTAN from the Centers for Medicare & Medicaid Services (CMS) to provide services under traditional Medicare, you will need a new and unique identifier for Railroad Medicare. You can request or find your Railroad Medicare PTAN with Palmetto GBA’s lookup tool.
If you wish to provide healthcare services under Railroad Medicare insurance, you will need to complete a separate enrollment. Railroad Medicare provider enrollment is not the same as an enrollment you complete with CMS to provide health services under traditional Medicare. You can enroll yourself, or a medical group you work with, via the Palmetto GBA website and lookup tool.
Before completing your RR Retirement Medicare provider enrollment, you or your provider group must be enrolled with your local Medicare Administrative Contractor (MAC). If you are already enrolled with CMS as a traditional Medicare provider, then you will already be enrolled with your MAC. At that point, you can contact Palmetto GBA to complete your Railroad Medicare provider enrollment.
Railroad Retirement Medicare is administered by the RRB while traditional Medicare is administered by the Social Security Administration. With the Railroad Medicare program, the RRB will take your Medicare premium from your Railroad Retirement Benefits or directly from you when you enroll.
The only difference between the two programs is the Federal agency that oversees them and the contractor that administers the Medicare Benefits. In the case of Railroad Medicare, this is the RRB and Palmetto GBA. While Railroad retirees have access to other retirements benefits and pension payments then Social Security beneficiaries, the health coverage under both Medicare programs is identical.
Railroad Medicare provides essential health coverage tailored to the needs of retired rail workers and their families. Understanding the specifics of this program, from eligibility and benefits to provider enrollment, can help beneficiaries and healthcare providers navigate the unique aspects of Railroad Medicare.
