What Is Medicare Railroad and How Does It Work?

Medicare Railroad is the dedicated health insurance program for qualified railroad workers and their families, operating under the federal Medicare system. Unlike standard Medicare, which the Social Security Administration (SSA) primarily administers, Medicare Railroad is managed by the U.S. Railroad Retirement Board (RRB). This distinct administration tailors health coverage for individuals with railroad industry service to their specific employment and retirement structures. The program provides essential health benefits, covering a range of medical services and associated costs for eligible beneficiaries.

Eligibility for Medicare Railroad

Individuals generally become eligible for Medicare Railroad upon reaching age 65, provided they are receiving or are qualified to receive railroad retirement benefits. This age requirement aligns with traditional Medicare eligibility.

For those under 65, eligibility can arise from specific disability conditions. Beneficiaries receiving monthly disability benefits for at least 24 months qualify, with coverage beginning in the 25th or 30th month of disability entitlement. Individuals diagnosed with Amyotrophic Lateral Sclerosis (ALS) are an exception, becoming eligible for Medicare coverage in the same month their annuity begins, without a waiting period. Permanent kidney failure also grants eligibility at any age, provided the individual receives dialysis or a kidney transplant and is eligible for railroad retirement benefits.

For premium-free Medicare Part A, an individual needs to have worked in the railroad industry for at least 10 years, equivalent to 40 quarters, and paid railroad retirement taxes.

Coverage and Associated Costs

Medicare Railroad provides comprehensive health coverage structured into different parts, similar to standard Medicare. These parts include Hospital Insurance (Part A), Medical Insurance (Part B), Medicare Advantage (Part C), and Prescription Drug Coverage (Part D).

Medicare Part A
Medicare Part A, known as Hospital Insurance, helps cover inpatient care received in hospitals and skilled nursing facilities following a hospital stay. It also extends to some home health care services and hospice care. For most railroad workers who have paid railroad retirement taxes for a sufficient period, 40 quarters, Part A is premium-free. If an individual does not meet this work history requirement, they may still enroll in Part A by paying a monthly premium. In 2025, the Part A deductible is $1,676, which is the amount a beneficiary pays before Medicare begins to cover costs for a hospital stay.

Medicare Part B
Medicare Part B, or Medical Insurance, covers services from doctors, outpatient care, medical supplies, and various preventive services. Unlike Part A, most beneficiaries pay a monthly premium for Part B. The standard monthly premium for 2025 is $185.00.

Individuals with higher modified adjusted gross incomes may pay an income-related monthly adjustment amount, leading to premiums ranging from $259.00 to $628.90 in 2025. The annual deductible for Part B is $257 in 2025, after which Medicare pays 80 percent of approved services, with the beneficiary responsible for the remaining 20 percent coinsurance. The Railroad Retirement Board is responsible for deducting these premiums from monthly benefit payments. Claims for Part B services for railroad beneficiaries are processed by Palmetto GBA.

Medicare Advantage
Medicare Advantage, or Part C, offers an alternative way to receive Medicare benefits. These plans are provided by private companies approved by Medicare and combine Part A and Part B coverage, often including Part D prescription drug coverage and additional benefits like vision or dental care. Beneficiaries must have both Part A and Part B and live within the plan’s service area to join a Medicare Advantage Plan. While these plans may offer lower copayments and extra benefits, beneficiaries still pay their Part B premium and any additional plan-specific premiums.

Medicare Part D
Medicare Part D provides voluntary coverage for prescription drugs through private plans. Beneficiaries pay a monthly premium, which averages around $36.78 in 2025, and a yearly deductible, up to $590 in 2025. Similar to Part B, higher-income beneficiaries may also pay an income-related monthly adjustment amount for Part D premiums. The Railroad Retirement Board can withhold Part D premiums and income-related adjustments from benefit payments, similar to Part B.

Enrollment Steps

Enrolling in Medicare Railroad involves specific procedures, with some individuals automatically enrolled while others need to take direct action. For those already receiving Railroad Retirement or disability benefits at least four months before their 65th birthday, enrollment in Medicare Parts A and B is automatic. Coverage begins on the first day of the month the individual turns 65. After automatic enrollment, beneficiaries receive their Medicare card, which will distinctly feature “Railroad Retirement Board” at the bottom.

If an individual is not automatically enrolled because they are not yet receiving railroad retirement benefits, they must contact the Railroad Retirement Board directly to apply for Medicare. This manual enrollment process involves reaching out to a local RRB office by phone or in person, as online enrollment is not available through the RRB. It is advisable to contact the RRB approximately three months before turning 65 to initiate the application.

The Initial Enrollment Period (IEP) for Medicare Railroad beneficiaries spans seven months. This period begins three months before the month of their 65th birthday, includes the birthday month, and extends for three months afterward. If enrollment is delayed beyond this period and the individual does not qualify for a Special Enrollment Period (SEP), such as through active employment coverage, they may face late enrollment penalties. For those who miss their IEP and do not qualify for an SEP, enrollment is possible during the General Enrollment Period (GEP) from January 1 to March 31 each year, with coverage starting the month after enrollment. The RRB directly handles the deduction of Medicare premiums from a beneficiary’s railroad retirement checks.