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How does Medicare work with railroad retirement benefits?

spinner image medicare railroad insurance benefits card
Railroad retirees are eligible for Medicare, but their cards have a Railroad Retirement Board red bar across the bottom and the federal agency's logo at the top.

Retired railroad workers receive Railroad Retirement Board benefits rather than Social Security.

People in both groups can receive health insurance coverage from Medicare. But railroad retirees need to take different steps than Social Security recipients to sign up for Medicare, pay their Medicare bills and check on their claims.

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What is Railroad Medicare?

Railroad Medicare, the Medicare program for people in the railroad retirement system, has the same benefits and enrollment periods as regular Medicare. While the Social Security Administration handles Medicare enrollment for people who receive Social Security, the U.S. Railroad Retirement Board handles Medicare enrollment and other administrative features for retired railroad workers.

In the 1930s, Congress created a national Railroad Retirement Board for train workers that is similar to but separate from the Social Security system. Railway workers remit payroll taxes to the Railroad Retirement Board to finance the program, similar to Social Security payroll taxes. Both groups also pay a Medicare payroll tax. 

The number of Railroad Medicare recipients is small compared with Social Security beneficiaries. At the end of September 2022, about 506,000 railroad retirees and survivors were receiving retirement benefits, and some are younger than Medicare age. The number of Medicare recipients 65 and older at the end of December 2022 was about 57.3 million.

How do I enroll in Railroad Medicare?

If you already receive Railroad Retirement Board benefits or railroad disability payments at least four months before your 65th birthday, the board will automatically enroll you in Medicare Parts A and B. Coverage takes effect the beginning of the month you turn 65.

You can delay enrolling in Part B and will have a special enrollment period to sign up later if you’re still working

If you aren’t receiving federal railroad benefits yet, you need to take steps to enroll. The Railroad Retirement Board doesn’t let you enroll online, but you have several options:

  • Call the board at 877-772-5772. 
  • Visit a Railroad Retirement Board field office. You can find contact information and locations using the agency’s field office locator.  
  • Send a secure email to your nearest railroad board office through the link in the field office locator. 

The initial enrollment period is the same as for Medicare, beginning three months before the month you turn 65 through the three months following your 65th birthday. 

You also can sign up during a special enrollment period while you or your spouse are working or within eight months of leaving your job.

You can enroll by phone, mail or visit a Railroad Retirement Board field office. But you need to submit an extra form to verify that you had employer-provided coverage and are eligible for a special enrollment period.

If you miss those enrollment periods, you can sign up for Part B during the general enrollment period from Jan. 1 to March 31 each year. But you may have a late enrollment penalty if you didn’t have employer coverage, which is the same as rules for other Medicare beneficiaries who sign up during the general enrollment period. 

How are the premiums handled for Railroad Medicare?

Medicare premiums are the same for railroad retirees as they are for those in the Social Security system. The difference is in how you pay your premiums.  

If you’re receiving railroad retirement benefits, Medicare will deduct your Part B premiums from your monthly benefits. If you’re not yet receiving the benefits, you can pay your Medicare premiums online at or by mail: 

Railroad Retirement Board
Medicare Premium Payments
P.O. Box 979024
St. Louis, MO 63197-9000 

You also can request payroll deduction through a third party, such as your employer. 


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How are Medicare claims handled for Railroad Medicare?

Another difference between Medicare for Social Security recipients and Medicare for railroad workers is how claims are handled. Medicare processes all Part A hospital claims, but Palmetto GBA, a subsidiary of Blue Cross Blue Shield, handles Part B claims for railroad retirement beneficiaries nationwide.

Make sure your providers submit claims to Palmetto GBA for all Part B services. You can either phone in claim questions at 800-833-4455 or visit the company’s website.

Review your quarterly Medicare Summary Notices to check the status of claims by using the MyRRMed online portal or through your online Medicare account

Just like other Medicare recipients, Railroad Medicare beneficiaries can get Part D prescription coverage and a Medicare supplement plan, also known as Medigap, or they can enroll in a private Medicare Advantage plan.

Keep in mind

Railroad Medicare cards look similar to a traditional Medicare card but with “Railroad Retirement Board” at the bottom. Notify your providers if you have Railroad Medicare, so they know where to submit claims. 

aIf needed, you can request a replacement Medicare card on the RRB’s online request form or call the help line at 877-772-5772, as well as print a copy of your card from your online Medicare account.

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