The Centers for Medicare & Medicaid Services (CMS) has released the Part B premium and deductible costs for 2023. Railroad Medicare processes claims for Part B services.

This year saw a modest decrease in both costs. The 2023 annual Part B deductible decreased from $233 to $226, a $7.00 difference. The 2023 standard Part B premium amount also decreased from $170.10 in 2022 to $164.90 in 2023, which is a difference of $5.20. Per CMS, most people pay $164.90, although those with higher or lower incomes have monthly adjusted amounts.

The following table shows the monthly premium payments based on your 2021 income:

If you filed an INDIVIDUAL Tax Return with income in 2021 of If you filed a JOINT Tax Return with income in 2021 ofIf you are married but filed a separate tax return with income in 2021 ofPart B premium you will pay each month in 2023
$97,000 or less$194,000 or less$97,000 or less$164.90
Above $97,000 up to $123,000Above $194,000 up to $246,000Not applicable$230.80
Above $123,000 up to $153,000Above $246,000 up to $306,000Not applicable$329.70
Above $153,000 up to $183,000Above $306,000 up to $366,000Not applicable$428.60
Above $183,000 and less than $500,000Above $366,000 and less than $750,000Above $97,000 and less than $403,000$527.50
$500,000 or above$750,000 or above$403,000 or above$560.50

If you have questions about your Part B Premium, you can call the Railroad Retirement Board toll free at 877-772-5772, or for the hearing impaired (TTY) call 312-751-4701. General information can also be found at the RRB’s website at www.RRB.gov.

If you have questions about your Railroad Medicare coverage, you can call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET.

You are encouraged sign up for Palmetto’s free internet portal, MyRRMed. MyRRMed provides you with access to your claims information, along with historical Medicare Summary Notices, and a listing of individuals you have authorized to have access to your protected health information (PHI). You can also submit requests to add or change your authorized representatives through the portal. To access MyRRMed, please visit www.PalmettoGBA.com/MyRRMed.


Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board.

Mental health is one of those things that we don’t want to talk about too much. With so much still unknown about the coronavirus, many people are still depressed, anxious, scared and stressed. We’ve watched how the world has changed during the pandemic, with millions of people losing their lives, and there is still a stigma related to the virus. Wear a mask. Don’t wear a mask. In the beginning, the coronavirus was thought to only affect the elderly population, but now, a year later, we know that to be untrue. Isolation, food and supply shortages were all things we dealt with during the pandemic.
Now the world is starting to open back up after more than a year of being isolated from families and friends. Many people are asking, “How do we ever get back to being normal?” One thing we can do is get vaccinated. Vaccines are now available to all people over the age of 12, and they are reducing the number of COVID-19 deaths and severe illnesses. In fact, 79.5% of those fully vaccinated are people 65 years or older. The COVID-19 vaccine is free to all Medicare beneficiaries.
Even though the pandemic is not over, (with the Delta variant a new concern) it is under better control. Americans are starting to travel again, see family and attend events with larger crowds. While these are good things, some of this news can cause many people to feel overwhelmed. According to the Centers for Disease Control and Prevention (CDC), “It is natural to feel stress, anxiety, grief and worry during the COVID-19 pandemic.”
Below are ways that you can help yourself, others and your community manage stress:

  • Turn the TV off. Reduce exposure to news stories, which can trigger stress.
  • Eat healthy, go for a walk and get plenty of sleep.
  • Find a new hobby or make time to do an old one.
  • Connect with others either in person or by phone.
  • Connect with your community or faith-based organizations. (CDC, 2021)

While we all wait for the World Health Organization to declare the COVID-19 pandemic over, we must still take proper precautions to ensure safety. If you are unvaccinated, according the CDC, you will still need to wear your mask. Seeing others not wearing a mask may also be stressful because you can’t be sure they are vaccinated.
If you are having trouble managing your feelings or not feeling like yourself, see your doctor or other approved healthcare provider and tell them how you are feeling. Don’t wait until your next annual wellness visit. Even if you don’t feel up to (or ready to face) getting out for a visit, many doctors today are offering telehealth visits. Some Medicare benefits you may not know of include:

  • Yearly depression screening
  • Diagnostic testing
  • Family counseling
  • Psychiatric evaluation
  • Individual and group psychotherapy
  • Medication management
  • Annual wellness visit
  • Caregiver-focused behavioral health risk assessment of their own behavior and health risks, which benefits the patient
  • Cognitive assessment and care planning
  • Drug therapy
  • Drug withdrawal treatment and other substance use disorder treatments
  • Hypnotherapy
  • Initial Preventive Physical Examination (IPPE) to review medical and social health history and provide preventive services education

For more information about your Medicare benefits and how they can help you get help when you’re feeling down, please call Palmetto GBA’s beneficiary contact center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. You are also encouraged to sign up for Palmetto’s email updates. To do so, click “Email Updates” on the top banner on the Palmetto GBA website at www.PalmettoGBA.com/RR/Me to start the process.
If you’d like to read more about the CDC and its information on coping with stress related to the coronavirus, please visit their website: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html


Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.

Do you or a loved one have any of the following symptoms?
It’s easy to forget where you put your car keys once in a while. But if you or a loved one have any of the following problems, please read further:

  • Trouble remembering
  • Difficulty learning new things
  • Feeling overwhelmed making decisions
  • Getting confused easily or frequently
  • Becoming very impulsive or showing poor judgment

You might think your memory has “slipped,” but it might be more than that. Medicare offers a service to test your cognitive functioning. It’s called a cognitive assessment, and it can be performed when you see your provider for a visit. Many times, it is performed when you do your yearly wellness visit, but it can be performed at any time you have a concern.
It’s really helpful if you bring someone with you to that visit, such as a friend, spouse or caregiver, so that they can provide answers to questions you might not know the answers to. During the visit, your doctor will do the following:

  1. Perform a cognitive exam.
  2. Review your medical history and your medication. Sometimes medications can have side effects that may make you appear to have a cognitive impairment.
  3. Develop a plan of care, if one is needed.
  4. Make a referral to a specialist, if one is needed.
  5. Talk to you about community resources (these can include adult daycare, rehabilitation services, and more).

When this service is performed, the Part B deductible and coinsurance apply.
Cognitive impairment doesn’t always present in the ways noted above. It can also show up as depression, anxiety, apathy or irritation/aggression. If you see these in yourself or others, please make an appointment with your doctor. Having mild cognitive impairment can increase your risk of developing dementia caused by Alzheimer’s. Per the Mayo Clinic, “some people with mild cognitive impairment never get worse, and a few eventually get better.” Be the one who gets better. Call your doctor today.
If you need help locating a doctor, you can call our Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. You are invited to use Palmetto’s free internet portal, MyRRMed, to access claim status, historical Medicare Summary Notices, and review any individuals you have authorized to have access to your private medical information. You can visit MyRRMed at www.PalmettoGBA.com/MyRRMed.
We also encourage you to visit the Mayo Clinic website, which discusses mild cognitive impairment (MCI) here: https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578.
You can also access the Alzheimer’s Association website, which discusses cognitive assessment services, by visiting here: https://www.alz.org/professionals/health-systems-clinicians/cognitive-assessment.


Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.

Medicare pays for an Annual Wellness Visit (AWV). It’s an awesome free preventive service that so many Medicare patients have not been taking advantage of. Since the onset of COVID-19, the number of AWVs being performed has fallen drastically, as many people have chosen to put off elective services. However, it’s important for you to do what is best for your health. That also means it may be best to take the time to have this service. If you talk to your healthcare provider and they say that it’s safe for you to have an AWV, then it makes sense to consider doing so.
First off, what is an AWV?
An Annual Wellness Visit is a visit to develop or update a preventive services plan that is personalized to your needs and to perform a Health Risk Assessment (HRA). An AWV comes in two sizes: your initial AWV and your follow-up AWV. Your initial AWV sets the baseline for future visits. Before or during this visit, you will complete a Health Risk Assessment (HRA) questionnaire, which will collect at a minimum:

  1. Your demographic data and a health status self-assessment
  2. Your assessment of depression/life satisfaction, stress, anger, pain, fatigue, isolation or loneliness
  3. Information on behavioral risks, including, but not limited to, if you smoke or use tobacco products, drink alcohol or use drugs, your physical activity and your nutrition
  4. Information on your ability to do general activities of daily living, such as washing clothes, bathing, walking, ability to stand for periods of time, etc.

During an initial AWV, your provider will create a baseline of your medical and family history, capture information about your current list of doctors and medications that you take, and gather measurements of your height, weight, blood pressure and other routine measurements as they apply based on your medical and family history. Your provider may also perform a cognitive impairment assessment to check for Alzheimer’s disease or dementia, and for depression and other mood disorders.
Your healthcare provider will review all of the information you provided to them, along with what they have observed focusing on your ability to do general activities of daily living, your risk of falling, plus any hearing impairments or potential home safety issues that may come up during the visit.
From all of this, your provider will create a written schedule/checklist, for the next five to 10 years for future screening visits and preventive services. Your provider will also give you personalized referrals for health education, preventive programs or counseling services based on what the AWV data has shown them.
These recommended services or programs can help you reduce risk factors or promote wellness, such as increasing weight loss and physical activity, as well as preventing falls and improving your nutrition. Referrals can be made for programs to help you quit smoking. You can also work with your provider to produce Advanced Care Planning documents such as living wills, advanced directives and other documents that instruct others about your healthcare wishes in the event you are unable to do so due to injury or illness.
That’s the first AWV. The second type of AWV is considered a follow-up AWV, or just a plain AWV.
At this AWV visit, you will review and update your HRA and your provider will update your medical/family history, the list of your current providers and medications and your measurements – including weight and blood pressure. Your provider will then make any needed changes to your screening schedule and your personalized health plan, and make new referrals, if necessary, to keep current with your needs. It is important to have this service every year. Your body is constantly changing – every day, every week, every month, every year. You take care of your plants, your car, your family, and you need to remember to take care of yourself as well.
How often can you get an AWV?
You can receive an AWV if:

  • It has been more than 12 months since the effective date of your first Medicare Part B coverage period, and
  • You have not received an Initial Preventive Physical Examination (IPPE, or “Welcome to Medicare” exam ) or an AWV within the past 12 months.

Where can I get an AWV?
Many healthcare providers are authorized to perform AWV services. They include:

  • Doctors of Medicine (MD) or Osteopathy (MO)
  • Physician’s assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS)
  • A medical professional (including a health educator, registered dietitian, nutrition professional or other licensed practitioners) or a team of medical professionals working under the direct supervision of a physician.
  • Teaching physicians in graduate medical education programs can perform these services in certain specific circumstances.

If you have a question about the AWV, please call Palmetto GBA’s toll-free Beneficiary Contact Center at 800-833-4455, from 8:30 a.m. until 7 p.m. ET Monday through Friday. They offer a TTY/TDD line at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours as customer service representatives are available. Palmetto’s website is www.PalmettoGBA.com/RR/Me, and offers access to a free self-service internet portal, MyRRMed. MyRRMed offers you access to your healthcare data.
At this time, you can use the portal to access:

  • Status and details of your Railroad Medicare Part B claims;
  • Historical Medicare Summary Notices (MSNs) for your Railroad Medicare Part B claims;
  • A listing of individuals you have authorized to have access to your private health information; and
  • You can also submit a request to add an authorized representative or to edit or remove an existing authorized representative.

To sign up for MyRRMed, visit www.PalmettoGBA.com/MyRRMed.

While we are coming up to the one-year anniversary of the coronavirus being present in the United States, we are happy to report that Medicare is taking action with the administration of the coronavirus vaccine across the country.
As the vaccinations roll out, we are receiving questions about the process, and we would like to share them and the answers with you. They are:
What does the vaccine cost?
The vaccine is free. Medicare will pay your provider for administering the vaccine, and you will not be charged in any way. If a provider tries to collect co-pays or any other types of funds specific to the coronavirus vaccine (such as coinsurances or deductibles), please call our office and let us know.
How is the vaccine being distributed?
Every state has its own vaccine distribution plan, and you can access that information from each state’s health department. To find a listing of states and their health departments, their websites and phone numbers, please see the article “What You Don’t Know May Make A Difference” on the Palmetto GBA website at www.PalmettoGBA.com/RR/Me. You can also find a listing on the Centers for Disease Control and Prevention (CDC) website at www.CDC.gov.
Where can I find out more about the individual vaccines?
There are two vaccines being used. They are Pfizer-BioNTech COVID-19 vaccine and Moderna’s COVID-19 vaccine​​. Additionally, per the CDC, there are three large-scale (Phase 3) clinical trials in progress or being planned for three COVID-19 vaccines:

AstraZeneca’s COVID-19 vaccine

Janssen’s COVID-19 vaccine

Novavax’s COVID-19 vaccine​

As each vaccine is approved and authorized, the CDC publishes information on who should or should not receive that particular vaccine based on health profiles. Additionally, the CDC will publish information to include the vaccine’s ingredients, its safety and its effectiveness. This information is located on the CDC website at www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.
Can I get my shot sooner if I pay for that?
The vaccine is available based on each state’s distribution program. If someone contacts you and tells you that you can pay to either have your name put on a list to receive the vaccine (when you were not on the list yet to receive the shot) or tells you that you can pay to receive the vaccine sooner than you are scheduled for, do not believe them. These “opportunities” do not exist. And as always, do not share your personal and financial information with people who call, text or email you with any offer like this. Keep your private information private. The government will never call you and ask you for money.
If you have a question about Medicare’s coverage of the coronavirus vaccine, please call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer service representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET.
You are encouraged to visit the Palmetto GBA website at www.PalmettoGBA.com/RR/Me, as well as enrolling to use their free self-service internet portal, MyRRMed. MyRRMed offers you access to your healthcare data. At this time, you can use the portal to access:

  • Status and details of your Railroad Medicare Part B claims
  • Historical Medicare Summary Notices (MSNs) for your Railroad Medicare Part B claims
  • A listing of individuals you have authorized to have access to your private health information.
  • You can also submit a request to add an authorized representative or to edit or remove an existing authorized representative.

To sign up for MyRRMed, please visit the site at www.PalmettoGBA.com/MyRRMed.


Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.

The federal Medicare program provides hospital and medical insurance protection for Railroad Retirement annuitants and their families, just as it does for Social Security beneficiaries. Medicare has the following parts:

  • Medicare Part A (hospital insurance) helps pay for inpatient care in hospitals and skilled nursing facilities (following a hospital stay), some home health care services and hospice care. Part A is financed through payroll taxes paid by employees and employers.
  • Medicare Part B (medical insurance) helps pay for medically-necessary services like doctors’ services and outpatient care. Part B also helps cover some preventive services. Part B is financed by premiums paid by participants and by federal general revenue funds.
  • Medicare Part C (Medicare Advantage Plans) is another way to get Medicare benefits. It combines Part A, Part B, and sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare.
  • Medicare Part D (Medicare prescription drug coverage) offers voluntary insurance coverage for prescription drugs through Medicare prescription drug plans and other health plan options.

The following questions and answers provide basic information on Medicare eligibility and coverage, as well as other information on the Medicare program.
1. Who is eligible for Medicare?
All Railroad Retirement beneficiaries age 65 or over and other persons who are directly or potentially eligible for Railroad Retirement benefits are covered by the program. Although the age requirements for some unreduced Railroad Retirement benefits have risen just like the Social Security requirements, beneficiaries are still eligible for Medicare at age 65.
Coverage before age 65 is available for disabled employee annuitants who have been entitled to monthly benefits based on total disability for at least 24 months and have a disability insured status under Social Security law. There is no 24-month waiting period for those who have ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig’s disease.
If entitled to monthly benefits based on an occupational disability, and the individual has been granted a disability freeze, he or she is eligible for Medicare starting with the 30th month after the freeze date or, if later, the 25th month after he or she became entitled to monthly benefits. If receiving benefits due to occupational disability and the person has not been granted a disability freeze, he or she is generally eligible for Medicare at age 65. (The standards for a disability freeze determination follow Social Security law and are comparable to the medical criteria a person must meet to be granted a total disability.)
Under certain conditions, spouses, divorced spouses, surviving divorced spouses, widow(er)s, or a dependent parent may be eligible for Medicare hospital insurance based on an employee’s work record when the spouse, etc., turns 65. Also, disabled widow(er)s under 65, disabled surviving divorced spouses under 65, and disabled children may be eligible for Medicare, usually after a 24-month waiting period.
Medicare coverage at any age on the basis of permanent kidney failure requiring hemodialysis or receipt of a kidney transplant is also available to employee annuitants, employees who have not retired but meet certain minimum service requirements, spouses and dependent children. The Social Security Administration has jurisdiction over Medicare in these cases. Therefore, a Social Security office should be contacted for information on coverage for kidney disease.
2. How do persons enroll in Medicare?
If a retired employee or a family member is receiving a Railroad Retirement annuity, enrollment for both Medicare Part A and Part B is generally automatic and coverage begins when the person reaches age 65. For beneficiaries who are totally disabled, both Medicare Part A and Part B start automatically with the 30th month after the beneficiary became disabled or, if later, the 25th month after the beneficiary became entitled to monthly benefits. Even though enrollment is automatic, an individual may decline Part B; this does not prevent him or her from applying for Part B at a later date. However, premiums may be higher if enrollment is delayed. (See question five for more information on delayed enrollment.)
If an individual is eligible for, but not receiving an annuity, he or she should contact the nearest Railroad Retirement Board (RRB) office before attaining age 65 and apply for both Part A and Part B. (This does not mean that the individual must retire, if working.) The best time to apply is during the three months before the month in which the individual reaches age 65. He or she will then have both Part A and Part B protection beginning with the month age 65 is reached. If the individual does not enroll for Part B in the three months before attaining age 65, he or she can enroll in the month age 65 is reached, or during the three months that follow, but there will be a delay of 1 to 3 months before Part B is effective. Individuals who do not enroll during this “initial enrollment period” may sign up in any “general enrollment period” (January 1 – March 31 each year). Coverage for such individuals begins July 1 of the year of enrollment.
3. Are there costs associated with Medicare Part A (hospital insurance)?
Yes. While individuals don’t have to pay a premium to receive Medicare Part A, recipients of Part A benefits are billed by the hospital for a deductible amount ($1,364 in 2019), as well as any coinsurance amount due and any noncovered services. The remainder of the bill from the hospital, as well as bills for services in skilled nursing facilities or home health visits, is sent to Medicare to pay its share.
4. What are the costs associated with Medicare Part B (medical insurance)?
Anyone eligible for Medicare hospital insurance (Part A) can enroll in Medicare medical insurance (Part B) by paying a monthly premium. The standard premium is $135.50 in 2019. However, some Medicare beneficiaries will not pay this amount because of a provision in the law that states Part B premiums for current enrollees cannot increase by more than the amount of the cost-of-living increase for Social Security (Railroad Retirement Tier I) benefits. Since that adjustment was 2.8 percent for 2019, about 2 million Medicare beneficiaries saw an increase in their Part B premiums, but still pay less than $135.50. The standard premium amount applies to new enrollees in the program, and certain beneficiaries who pay higher premiums based on their modified adjusted gross income.
Monthly premiums for some beneficiaries are greater, depending on a beneficiary’s or married couple’s modified adjusted gross income. The income-related Part B premiums for 2019 are $189.60, $270.90, $352.20, $433.40, or $460.50, depending on how much a beneficiary’s modified adjusted gross income exceeds $85,000 ($170,000 for a married couple), with the highest premium rates only paid by beneficiaries whose modified adjusted gross incomes are over $500,000 ($750,000 for a married couple).
There is also an annual deductible ($185 in 2019) for Part B services.
Palmetto GBA, a subsidiary of Blue Cross and Blue Shield, generally processes claims for Part B benefits filed on behalf of Railroad Retirement beneficiaries in the Original Medicare Plan (the traditional fee-for-service Medicare plan). An individual in the Original Medicare Plan should have his or her hospital, doctor, or other health care provider submit Part B claims directly to:

Palmetto GBA
Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001
1-800-833-4455
www.palmettogba.com/medicare

Persons with questions about Part B claims under the Original Medicare Plan can contact Palmetto GBA as noted above.
5. Can Medicare Part B premiums increase for delayed enrollment?
Yes. Premiums for Part B are increased 10% for each 12-month period the individual could have been, but was not, enrolled. However, individuals age 65 or older who wait to enroll in Part B because they have group health plan coverage based on their own or their spouse’s current employment may not have to pay higher premiums because they may be eligible for “special enrollment periods.” The same special enrollment period rules apply to disabled individuals, except that the group health insurance may be based on the current employment of the individual, his or her spouse or a family member.
Individuals deciding when to enroll in Medicare Part B must consider how this will affect eligibility for health insurance policies which supplement Medicare coverage. These include “Medigap” insurance and prescription drug coverage and are explained in the answers to questions six through eight.
6. What is Medigap insurance?
Many private insurance companies sell insurance, known as “Medigap,” that helps pay for services not covered by the Original Medicare Plan. Policies may cover deductibles, coinsurance, copayments, health care outside the United States and more. Generally, individuals need Medicare Part A and Part B to enroll, and a monthly premium is charged. When someone first enrolls in Medicare Part B at age 65 or older, he or she has a one-time 6-month “Medigap open enrollment period.” During this period, an insurance company cannot deny coverage, place conditions on a policy, or charge more for a policy because of past or present health problems.
7. Do Medicare beneficiaries have choices available for receiving health care services?
Yes. Under the Original Medicare Plan, the fee-for-service Medicare plan that is available nationwide, a beneficiary can see any doctor or provider who accepts Medicare from qualified Railroad Retirement beneficiaries and is accepting new Medicare patients. Those enrolled in the Original Medicare Plan who want prescription drug coverage must join a Medicare prescription drug plan as described in question eight.
However, a beneficiary may opt to choose a Medicare Advantage Plan (Part C) instead. These plans are managed by Medicare-approved private insurance companies. Medicare Advantage Plans combine Medicare Part A and Part B coverage, and are available in most areas of the country. An individual must have Medicare Part A and Part B to join a Medicare Advantage Plan, and must live in the plan’s service area. Medicare Advantage Plan choices include regional preferred provider organizations (PPOs), health maintenance organizations (HMOs), private fee-for-service plans and others. A PPO is a plan under which a beneficiary uses doctors, hospitals and providers belonging to a network; beneficiaries can use doctors, hospitals and providers outside the network for an additional cost. Under a Medicare Advantage Plan, a beneficiary may pay lower copayments and receive extra benefits. Most plans also include Medicare prescription drug coverage (Part D).
8. How does Medicare Part D (Medicare prescription drug coverage) work?
Medicare contracts with private companies to offer beneficiaries voluntary prescription drug coverage through a variety of options, with different covered prescriptions and different costs. Beneficiaries pay a monthly premium (averaging about $33 in 2019), a yearly deductible (up to $415 in 2019) and part of the cost of prescriptions. Those with limited income and resources may qualify for help in paying some prescription drug costs.
The Affordable Care Act requires some Part D beneficiaries to also pay a monthly adjustment amount, depending on a beneficiary’s or married couple’s modified adjusted gross income. The Part D income-related monthly adjustment amounts in 2019 are $12.40, $31.90, $51.40, $70.90, or $77.40, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $85,000 ($170,000 for a married couple), with the highest amounts only paid by beneficiaries whose incomes are over $500,000 ($750,000 for a married couple).
To enroll, individuals must have Medicare Part A and live in the prescription drug benefit plan’s service area. Beneficiaries can join during the period that starts three months before the month their Medicare coverage starts and ends three months after that month. There may be a higher premium if an individual does not join a Medicare drug plan when first eligible. A beneficiary can generally join or change plans once each year during an enrollment period from October 15 through December 7. Drug coverage would then begin January 1 of the following year. In most cases, there is no automatic enrollment to get a Medicare prescription drug plan. Individuals enrolled in Medicare Advantage Plans will generally get their prescription drug coverage through their plan.
9. Where can I get more information about the Medicare program?
General information on Medicare coverage for Railroad Retirement beneficiaries is available on the RRB’s website, RRB.gov, under the Benefits tab (Medicare) or by contacting an RRB field office toll-free at 1-877-772-5772.
More detailed information on Medicare’s benefits, costs, and health care options are available from the Center for Medicare & Medicaid Services (CMS) publication Medicare & You, which is mailed to Medicare beneficiary households each fall and to new Medicare beneficiaries when they become eligible for coverage. Medicare & You and other publications are also available by visiting Medicare’s website, Medicare.gov, or by calling the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227).

The Centers for Medicare & Medicaid Services has announced that the standard monthly Part B premium will be $135.50 in 2019, a slight increase from $134.00 in 2018. However, some Medicare beneficiaries will pay slightly less than this amount. By law, Part B premiums for current enrollees cannot increase by more than the amount of the cost-of-living adjustment for social security (railroad retirement tier I) benefits.

Since that adjustment is 2.8 percent in 2019, about 2 million Medicare beneficiaries will see an increase in their Part B premiums but still pay less than $135.50. The standard premium amount will also apply to new enrollees in the program, and certain beneficiaries will continue to pay higher premiums based on their modified adjusted gross income.

The monthly premiums that include income-related adjustments for 2019 will range from $189.60 up to $460.50, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $85,000 (or $170,000 for a married couple). The highest rate applies to beneficiaries whose incomes exceed $500,000 (or $750,000 for a married couple). The Centers for Medicare & Medicaid Services estimates that about 5 percent of Medicare beneficiaries pay the larger income-adjusted premiums.

Beneficiaries in Medicare Part D prescription drug coverage plans pay premiums that vary from plan to plan. Part D beneficiaries whose modified adjusted gross income exceeds the same income thresholds that apply to Part B premiums also pay a monthly adjustment amount. In 2019, the adjustment amount ranges from $12.40 to $77.40.

The Railroad Retirement Board withholds Part B premiums from benefit payments it processes. The agency can also withhold Part C and D premiums from benefit payments if an individual submits a request to his or her Part C or D insurance plan.

The following tables show the income-related Part B premium adjustments for 2019. The Social Security Administration (SSA) is responsible for all income-related monthly adjustment amount determinations. To make the determinations, SSA uses the most recent tax return information available from the Internal Revenue Service. For 2019, that will usually be the beneficiary’s 2017 tax return information. If that information is not available, SSA will use information from the 2016 tax return.

Those railroad retirement and social security Medicare beneficiaries affected by the 2019 Part B and D income-related premiums will receive a notice from SSA by the end of the year. The notice will include an explanation of the circumstances where a beneficiary may request a new determination. Persons who have questions or would like to request a new determination should contact SSA after receiving their notice.

Additional information about Medicare coverage, including specific benefits and deductibles, can be found at www.medicare.gov.

2019 PART B PREMIUMS 

Beneficiaries who file an individual tax return with income:

Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly Part B premium amount

 

Less than or equal to $85,000 

Less than or equal to $170,000

$0.00

$135.50

Greater than $85,000 and less than or equal to $107,000 

Greater than $170,000 and less than or equal to $214,000

$54.10

$189.60

Greater than $107,000 and less than or equal to $133,500 

Greater than $214,000 and less than or equal to $267,000

$135.40

$270.90

Greater than $133,500 and less than or equal to $160,000

Greater than $267,000 and less than or equal to $320,000

$216.70

$352.20

Greater than $160,000 and less than $500,000

Greater than $320,000 and less than $750,000

$297.90

$433.40

$500,000 and above

$750,000 and above

$325.00

$460.50

 

The monthly premium rates paid by beneficiaries who are married, but file a separate return from their spouses and who lived with their spouses at some time during the taxable year, are different.  Those rates are as follows:

 

Beneficiaries who are married, but file a separate tax return, with income:

Income-related monthly adjustment amount

Total monthly Part B premium amount

Less than or equal to $85,000

$0.00

$135.50

Greater than $85,000 and less than $415,000

$297.90

$433.40

$415,000 and above

$325.00

$460.50

 

Most railroad retirement annuities, like social security benefits, will increase in January 2019 due to a rise in the Consumer Price Index (CPI) from the third quarter of 2017 to the corresponding period of the current year.
Cost-of-living increases are calculated in both the tier I and tier II benefits included in a railroad retirement annuity. Tier I benefits, like social security benefits, will increase by 2.8 percent, which is the percentage of the CPI rise. Tier II benefits will go up by 0.9 percent, which is 32.5 percent of the CPI increase. Vested dual benefit payments and supplemental annuities also paid by the Railroad Retirement Board (RRB) are not adjusted for the CPI change.
In January 2019, the average regular railroad retirement employee annuity will increase $60 a month to $2,808 and the average of combined benefits for an employee and spouse will increase $86 a month to $4,078. For those aged widow(er)s eligible for an increase, the average annuity will increase $34 a month to $1,398. However, widow(er)s whose annuities are being paid under the Railroad Retirement and Survivors’ Improvement Act of 2001 will not receive annual cost-of-living adjustments until their annuity amount is exceeded by the amount that would have been paid under prior law, counting all interim cost-of-living increases otherwise payable. Some 52 percent of the widow(er)s on the RRB’s rolls are being paid under the 2001 law.
If a railroad retirement or survivor annuitant also receives a social security or other government benefit, such as a public service pension, the increased tier I benefit is reduced by the increased government benefit. Tier II cost-of-living increases are not reduced by increases in other government benefits. If a widow(er) whose annuity is being paid under the 2001 law is also entitled to an increased government benefit, her or his railroad retirement survivor annuity may decrease.
However, the total amount of the combined railroad retirement widow(er)’s annuity and other government benefits will not be less than the total payable before the cost-of-living increase and any increase in Medicare premium deductions.
The cost-of-living increase follows a tier 1 increase of 2.0 percent in January 2018, which had been the largest in 6 years. The Centers for Medicare and Medicaid Services recently announced the Medicare Part B premiums for 2019, and this information is available at www.medicare.gov.
In late December the RRB will mail notices to all annuitants providing a breakdown of the annuity rates payable to them in January 2019.

Social Security and Supplemental Security Income (SSI) benefits for more than 67 million Americans will increase 2.8 percent in 2019, announced the Social Security Administration (SSA).
The 2.8 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 62 million Social Security beneficiaries in January 2019. Increased payments to more than 8 million SSI beneficiaries will begin on December 31, 2018. (Note: some people receive both Social Security and SSI benefits). The Social Security Act ties the annual COLA to the increase in the Consumer Price Index as determined by the Department of Labor’s Bureau of Labor Statistics.
Some other adjustments that take effect in January of each year are based on the increase in average wages. Based on that increase, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $132,900 from $128,400.
Social Security and SSI beneficiaries are normally notified by mail in early December about their new benefit amount. This year, for the first time, most people who receive Social Security payments will be able to view their COLA notice online through their mySocial Security account. People may create or access their my Social Security account online at www.socialsecurity.gov/myaccount.
Information about Medicare changes for 2019, when announced, will be available at www.medicare.gov. For Social Security beneficiaries receiving Medicare, Social Security will not be able to compute their new benefit amount until after the Medicare premium amounts for 2019 are announced. Final 2019 benefit amounts will be communicated to beneficiaries in December through the mailed COLA notice and my Social SecurityMessage Center.
The Social Security Act provides for how the COLA is calculated. To read more, please visit www.socialsecurity.gov/cola.
Click here for a fact sheet showing the effect of the various automatic adjustments.

When a natural disaster, extreme weather or other emergency occurs that affects providers and the Medicare beneficiaries that they serve, special emergency-related policies and procedures may be implemented.
The process begins when a governor of an affected state requests assistance. This is done if the event is beyond the combined response abilities of the state and local governments. From this request, the President of the United States can declare a Public Health Emergency (PHE), using the Robert T. Stafford Disaster Relief and Emergency Assistance Act.
Under Section 1135 or 1812(f) of the Social Security Act, the Centers for Medicare & Medicaid Services (CMS) can issue ‘blanket waivers’ for providers and suppliers when it comes to services that are provided by skilled nursing facilities, home health agencies and critical access hospitals. Measures are in place to assist with durable medical equipment and supplies, as well as quality reporting, extending the appeals time limit, and getting replacement prescription refills.
As an example in an impacted area, when a waiver is granted for submitting appeal requests (which normally would need to be filed 120 days from the date of the claim denial notification), an appeal may be filed after the 120 days based on CMS guidance.
The following are the most recent hurricane-related PHE’s for which HHS has authorized waivers:
2018 Waivers

  • Hurricane Michael – Florida (at the time of writing this article)
  • Hurricane Florence – North Carolina, South Carolina and Virginia

2017 Waivers

  • Hurricane Maria – Puerto Rico and the U.S. Virgin Islands
  • Hurricane Nate – Louisiana and Mississippi
  • Hurricane Irma – Florida, Georgia and South Carolina
  • Hurricane Harvey – Texas and Louisiana

Medicare has a toll-free helpline you can use if you are in an impacted area. This Disaster Distress Helpline is available 24/7. The toll-free, multilingual and confidential crisis support service can be reached by calling 1-800-985-5990. You can also text TalkWithUs to 66746 (for Spanish, press 2 or text Hablanos to 66746) to connect with a trained crisis counselor.
More information is available to you at the following address: https://www.hhs.gov/about/news/2018/10/09/hhs-secretary-azar-declares-public-health-emergency-florida-due-hurricane-michael.html
Hurricanes don’t discriminate in terms of destruction, and there are times when a person only has the clothes on their back – but no wallet or Medicare card to get assistance. If you lose your Medicare card, you can call our Beneficiary Customer Service Center at 800-833-4455, Monday through Friday, 8:30 a.m. until 7 p.m. ET to order a new one. For the hearing impaired, call TTY/TDD at 877-566-3572. You may also call the Railroad Retirement Board at 877-772-5772.
You are encouraged you to visit Palmetto GBA’s Facebook page at www.Facebook.com/MyRRMedicare, as well as their website at www.PalmettoGBA.com/RR/Me for more information.