General Information About Medicare
Medicare is a four-part Federal health insurance program, administered by the Centers for Medicare & Medicaid Services (CMS), for people who are age 65 or older, who are totally and permanently disabled, or who have permanent kidney failure. The four parts are Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage plans) and PartD (Medicare prescription drug coverage).
If you are eligible for Medicare because of permanent kidney failure (End Stage Renal Disease), you must call or visit your local Social Security Administration office or call the Social Security Administration at 1-800-772-1213 to enroll in Medicare Part A and Part B. For all other Medicare eligibility, the RRB can help you enroll in Medicare Part A and Part B.
Hospital Insurance (Part A) can help pay for four kinds of care:
- inpatient hospital care;
- inpatient care in a skilled nursing facility following a hospital stay;
- care in your home by a home health agency; and,
- hospice care.
As soon as you are determined to be eligible for Medicare, you will automatically be enrolled for Hospital Insurance (Part A). You do not pay a monthly premium for your Hospital Insurance (Part A).
Medical Insurance (Part B) can help pay for additional kinds of medically necessary care:
- doctors' services;
- outpatient hospital services; and,
- a number of other medical services and supplies that are not covered by Hospital Insurance
(Part A).
Medicare Advantage planes (Part C) like HMO's and PPO's are a way to get your Medicare coverage through private companies that are approved my Medicare. These plans include Part A, Part B, and usually other coverage like prescription drugs (Part D).
You usually pay a monthly premium (in addition to your Part B premium) and a co-payment or co-insurance amount for covered services. Costs, extra coverage, and rules vary by plan.
Prescription Drugs (Part D) helps cover the cost of prescription drugs. To enroll in a Medicare prescription drug plan, you must have Medicare Part A. Generally, you will have to pay a monthly premium, an annual deductible, and a share of the cost of each prescription.
When a person first becomes eligible for Medicare, they can enroll in a Medicare prescription drug plan during the period that starts three months before the month their Medicare coverage starts and ends three months after that month. If you do not join a drug plan when you are first eligible, you may have to pay a late enrollment penalty if you choose to join later. To enroll in a Part D plan you must contact the plan directly. The RRB does not process enrollments in Part D.
Medical Insurance (Part B) at Age 65 or Older - Enrollment for Medical Insurance (Part B) depends on your age when you file your annuity application.
- If you are under age 64 years and 5 months when you file your annuity application, you will be automatically enrolled in Medical Insurance (Part B) at age 65, unless you decline this coverage.
- If you are at least age 64 years and 5 months, when you file your annuity application, you can use your employee annuity application to enroll for Medical Insurance (Part B).
If you want Medical Insurance (Part B) at age 65, you must pay a premium for each month you have this insurance. If you receive an annuity, the premium will usually be deducted from your monthly annuity.
If you do not want Medical Insurance (Part B) at age 65, and then later decide that you do want to sign up, your protection may be delayed and your premiums may be more expensive.
If at any time, you wish to cancel the election that you make on your annuity application, you must contact the nearest office of the RRB.
Special Enrollment Period
You may delay enrolling in Medical Insurance (Part B) coverage without penalty if you are covered under a Group Health Plan (GHP) at age 65. The GHP must be based on your own employment or your spouse's employment. You may enroll in Medical Insurance (Part B) at any time while you are covered under the GHP; or, you can enroll during a Special Enrollment Period (SEP). Your SEP begins when the employment on which the GHP is based ends or the first month you are no longer covered under the GHP, whichever comes first. The SEP lasts for 8 months.
The beginning date of your Medical Insurance (Part B) coverage depends on the status of your GHP coverage when you file for the Medical Insurance (Part B).
- If you file for Medical Insurance (Part B) during any month in which you are enrolled in a GHP, or in the first month of your SEP, you can choose the effective date of your Medical Insurance (Part B). The effective date can be the first day of the month you file or the first day of any of the following three months after the month of filing.
Example 1 - If your GHP coverage based on current employment has not ended and you file for Medical Insurance (Part B) in May, you can chose May 1, June 1, July 1, or August 1 for your Medical Insurance (Part B) effective date.
Example 2 - If your GHP coverage based on current employment ends on March 19, and you file for Medical Insurance (Part B), the following applies:
- If you file anytime after March 19, but before April 1, you can choose the effective date of March 1, April 1, May 1, or June 1 for your Medical Insurance (Part B).
- If you file anytime in April, you can choose the effective date of April 1, May 1, June 1, or July 1 for your Medical Insurance (Part B).
- If you file for Medical Insurance (Part B) during the other seven months of your SEP, your Medical Insurance Part B) will begin the first day of the month after the month you file. The beginning date can be no later than the ninth month after the start of your SEP.
Example - If your GHP coverage based on employment ends on March 19, and you file for Medical Insurance (Part B) anytime during the period May 1 through November 30, your Medical Insurance (Part B) will begin the month after the month in which you file your annuity application.
If you are already enrolled in Medical Insurance (Part B) and are paying higher premiums due to late enrollment, and you had GHP coverage at age 65, you may use your annuity application to request a review of the Medical Insurance (Part B) premium rate you are paying.
Prescription Drugs
In 2003, new Medicare legislation was enacted. Among other things, the legislation provides for a prescription drug benefit for Medicare beneficiaries. Until that benefit goes into effect in 2006, Medicare beneficiaries will be able to purchase a prescription drug discount card. Individuals with incomes below certain levels may qualify for a $600 credit to be added to the discount card that can be used to help pay for prescription drugs.
Early Medicare Based on Disability
You can also be covered by Medicare before age 65 if you are eligible for a monthly railroad retirement annuity and are totally disabled for all employment. If you are filing for an age and service annuity before the month you will attain age 63, and you are totally disabled, you may use your annuity application to request a disability determination for early Medicare coverage only. Also complete and return Form AA-1D Application for Determination of Employee's Disability. Refer to booklet RB-1D, "Employee Disability Benefits" for an explanation of the disability requirements.
If you are filing for a disability annuity, the RRB will automatically do a disability determination for an RRA annuity and early Medicare coverage.
More Information About Medicare
If you need more information about Medicare, contact the nearest RRB field office. You may also find answers to your Medicare questions:
| Toll Free: |
1-800-MEDICARE (1-800-633-4227) |
| TTY/TDD: |
1-877-486-2048 |
| Website: |
www.medicare.gov |