Railroad personnel are covered by Medicare in the same way that they are by Social Security. Railroad retirement payroll taxes, like social security payroll taxes, contain a Medicare hospital insurance tax.
What is the difference between railroad Medicare and regular Medicare?
The main difference is that, regardless of where they live, retired railroad beneficiaries’ Part B benefits are administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC). When members obtain therapy, they should make sure to tell their providers.
Who is eligible for railroad retirement benefits?
You must have worked for a railroad for at least 10 years, or for at least 5 years after 1995, to be eligible for railroad retirement benefits. With 30 years of service, workers can get full retirement benefits at the age of 60. The RRB also provides benefits to railroad workers’ families and survivors.
How do I find railroad Medicare?
A person with Railroad Medicare has a special Medicare card, as seen below, with the RRB logo in the top left corner and the words “Railroad Retirement Board” at the bottom.
Does railroad Medicare require prior authorization?
Prior permission or precertification is not necessary for any Part B treatments billed to Palmetto GBA Railroad Medicare at this time, with the exception of the services indicated below. It’s critical that you check our website for updates to this policy as the Centers for Medicare & Medicaid Services (CMS) continues to expand its preauthorization and prior authorization programs.
- Certain Hospital Outpatient Department (OPD) Services are subject to a Prior Authorization (PA) Program.
For certain hospital outpatient department (OPD) services, the Centers for Medicare & Medicaid Services (CMS) has developed a countrywide prior authorization (PA) process and regulations.
Prior authorization is required for the hospital OPD claim for the following services for dates of service on or after July 1, 2020:
Prior authorization is required for the hospital OPD claim for the following services for dates of treatment on or after July 1, 2021:
Because the prior authorization is for an OPD treatment rather than a Part B professional service, PA requests must be sent to the jurisdictional Medicare Administrative Contractor (MAC) who will process the hospital outpatient department facility claim. Palmetto GBA Railroad Medicare does not accept PA requests. Services that require prior authorization as a condition of payment for hospital OPD claims will not be reimbursed for Part B claims for associated/related services, such as physician services conducted in hospital OPDs, if the service requiring prior authorization is not eligible for payment. For further information, visit our Prior Authorization (PA) page for the Outpatient Department (OPD).
When a claim for Part B services supplied to Railroad Medicare beneficiaries is billed to and processed by another Medicare Administrative Contractor, prior authorization may be necessary. For Medicare and Railroad Medicare patients, Part B claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) that are under DME MAC authority are invoiced to your local DME MAC. Medicare and Railroad Medicare patients are billed to your jurisdictional A/B MAC for Part B outpatient facility claims that you bill on UB-04 CMS-1450 forms or equivalent electronic claim forms. Any prior authorization or precertification restrictions that apply to the services you are billing to that MAC apply to Part B claims for Railroad Medicare patients that are filed to a DME MAC or jurisdictional A/B MAC.
What does a railroad Medicare number look like?
The Railroad Retirement Board (RRB) mailed about 450,000 new Railroad Medicare cards with new Medicare numbers in July of last year. The former Health Insurance Claim Numbers have been replaced by the new Medicare Numbers, which are unique to each person with Railroad Medicare and do not contain Social Security Numbers (SSNs) (HICNs). Until December 31, 2019, providers can bill claims to Medicare using either an HICN or a new Medicare Number.
Approximately 70% of the Railroad Medicare claims received at this time are submitted with Medicare numbers. Beginning January 1, 2020, all providers must submit claims using only Medicare numbers.
Remember to bring your new card with you to any doctor’s appointment or other Medicare service. Your provider’s office is aware that everyone should get a new Medicare number, and they will need to keep track of it so that Railroad Medicare can be properly billed.
If your physician does not have a copy of your card, they may be able to search up your information through our online provider portals with their local Medicare Administrative Contractor (MAC) or with Palmetto GBA Railroad Medicare. Authorized providers can access information like as claims history, eligibility, and more through these portals. Additionally, the portals include a function that allows doctors to seek up a Medicare Number using the following patient information:
Please note that a provider needs know your Social Security Number in order to utilize the program to seek for your Medicare Number. If you don’t want to reveal your SSN to a provider, offer them a copy of your card or tell them your Medicare number. You’re making it far more difficult for your providers to file claims on time if you haven’t used your card yet. One of the reasons for the new cards was to provide further security against identity theft. One approach to handle this is to be very picky about who you give your personal information to (your doctor, insurers, etc.).
Make sure you read your Medicare number accurately when providing it to a provider or a Customer Service Advocate while calling Railroad Medicare. Only numbers and uppercase letters are used in Medicare numbers, which are 11 characters long. They don’t have the letters S, L, O, I, B, or Z in them. One, four, seven, ten, and eleven will always be numbers. A letter will always be the second, fifth, eighth, and ninth characters. A letter or a number will be the third and sixth characters.
Your new Medicare card does not replace your plan’s identity card if you are enrolled in a Medicare Advantage Plan. To get your Medicare benefits, you will continue to utilize the ID card provided by your plan.
You can contact Palmetto’s Beneficiary Contact Center at 800-833-4455 or the Railroad Retirement Board at 877-772-5772 if you have not received your new Medicare Card with your new Medicare Number.
What are railroad benefits?
The Railroad Retirement Board is an organization that oversees the retirement of railroad employees In the 1930s, the Railroad Retirement Program was founded. Individuals who have worked for the railroad for a significant amount of their careers, as well as their families, are eligible for retirement, survivor, unemployment, and sickness benefits.