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medicare formWhen planning a foreign trip, it’s highly unlikely your first thought would be, “Will Medicare pay if I get injured or have a medical emergency before I get back home?”

Many patients think their Medicare benefits will provide coverage, wherever they go. Unfortunately, this isn’t true and can lead to costly, and avoidable, mistakes.

Generally, Medicare doesn’t pay for medical services to patients outside of the United States. Medicare describes the United States as the 50 states, the District of Columbia, Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands, the Northern Mariana Islands, and the territorial waters adjacent to these areas.

“United States,” in this interpretation, would not include any United States Armed Forces bases. So whether you are heading to Europe, the Caribbean, or anywhere outside the U.S., you may wish to consider travel insurance. Here’s why: Medicare only pays, under very limited circumstances, for a limited number of services outside the United States.

Medicare won’t pay for medical treatment or prescription drugs, even if you receive them on board cruise ships, unless the ship is in U.S. territorial waters. “Territorial Waters” means the ship is in a U.S. port, or within 6 hours of when the ship arrived at, or departed from a U.S. port.

The Centers for Medicare and Medicaid (CMS) have listed the rare instances in which other coverage may exist, such as for:

  • Emergency inpatient hospital services if you fall ill in the U.S, but the closest hospital that can treat you is outside of the U.S.
  • Emergency treatment at a Canadian hospital if you are traveling straight through Canada (between Alaska and another state) and the closest hospital you can be treated at is in Canada.

Should the services meet criteria for payment in those situations, physician and ambulance services may be covered as part of, or immediately prior to, that stay. However, Medicare will not pay for transport back to the U.S. after a medical emergency that occurs outside of the U.S.

Knowing this, when you plan a trip abroad, you may want to look into what coverage you do have. Some Medigap or Medicare supplemental plans have travel-related benefits. If you don’t have a supplemental plan, or that plan does not pay for services you might receive outside of the United States, you may want to purchase a travel insurance plan that includes medical coverage.

Don’t let the expense of an unplanned medical emergency ruin your travels. Plan ahead and have a great trip!

If you have questions about your Medicare benefits, call Medicare’s toll-free Beneficiary Contact Center at (800) 833-4455, Monday through Friday, from 8:30 a.m. until 7 p.m. ET. Medicare also offers 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 customer service representatives are available.

Visit Railroad Medicare’s website at www.PalmettoGBA.com/RR/Me. You can receive email updates about changes to the Railroad Medicare program by visiting its website and signing up in its ‘Stay Connected’ portion at the bottom left of the site.

You are also invited Railroad Medicare’s Facebook page at www.Facebook.com/MyRRMedicare.

 

Palmetto_rgb_webIf you find yourself in need of a doctor, and you don’t know if one practices near you, or if they participate in Medicare, and you have internet access, you can use the ‘Physician Compare’ tool at www.Medicare.gov.

Physician Compare is a website maintained by the Centers for Medicare and Medicaid Services (CMS), and it houses a wealth of information, including physicians’:

  • Names
  • Specialties
  • Gender
  • Addresses and phone numbers
  • Hospital affiliations
  • Medicare assignment status
  • Language spoken

If you don’t know what kind of doctor you need, you can use an advanced search and pick the part of your body that you would like a doctor to examine. The search tool asks more questions and leads you to a listing of doctors in your area who would be a good fit for you.

The website also provides you with maps and driving directions. If you have a MyMedicare.gov account you can save the search results in ‘your favorites’ (at www.MyMedicare.gov).

If you are looking for a practice/group of doctors by specialty, Physician Compare can find these for you, as well.

If you do not have access to the Internet, you can either call 1-800-MEDICARE or our Beneficiary Contact Center, and Customer Service Staff can do the search with you on the telephone. You can reach our toll-free Beneficiary Customer Service Line at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours Customer Service Representatives are available.

We encourage you to visit our Facebook page at https://www.facebook.com/myrrmedicare. We also invite you to join our listserv/e-mail updates. Just select the ‘E-Mail Updates’ in the ‘Stay Connected’ section on the lower left-hand side of our main webpage at www.PalmettoGBA.com/RR/Me.

Palmetto GBA logoWhen Medicare began in the 1960s, it was the primary payer for all services except those covered by workers compensation. In 1980, Congress enacted provisions to shift costs from the Medicare program to private insurers, when possible.

This legislation stopped Medicare from making payment if the payment had already been made, or would be expected to be made, by group health plans or workers’ compensation plans.

Medicare pays first when:

  • You have retiree insurance (from either you or your spouse’s former employment)
  • You’re 65 or older, have group health plan coverage based on your spouse’s current employment, and that employer has less than 20 employees
  • You’re under 65 and disabled, have group health plan insurance based on your or a family member’s current employer, and that employer has less than 100 employees
  • You’re also receiving Medicaid benefits

If you have group health care plan coverage that is primary to Medicare (pays first), it will continue to do so until it pays up to the limits of its coverage. Then Medicare becomes primary.

Medicare pays second when:

  • You’re 65 or older, have group health plan coverage based on your spouse’s current employment, and that employer has 20 or more employees
  • You’re under 65 and disabled, have group health plan insurance based on your or a family member’s current employer, and that employer has 100 or more employees
  • You have end-stage renal disease (ESRD) and you are in the first 30 months of your Medicare eligibility. Medicare pays first after that.
  • You’re covered by no-fault or liability insurance for any services related to an accident

For a detailed explanation of how Medicare works with other insurance coverage, go to www.medicare.gov/publications and view the booklet “Medicare and Other Health Benefits: Your Guide to Who Pays First.”

Insurance that pays after Medicare is referred to as supplemental insurance. Your retiree coverage may act as supplemental insurance, or you may purchase a Medigap policy from a private insurance company. For information about Medigap policies, visit www.medicare.gov/publications and view the booklet “Choosing a Medigap Policy: A Guide to People with Medicare.”

Medicare works with supplemental insurance companies through a process called “crossover.” Crossover is an automatic claim filing service used by Railroad Medicare and Medicare Part B contractors to send claim information to your supplemental insurance company after Palmetto GBA has processed a Medicare claim for you. This saves you the time of filing a claim with your supplemental insurer.

In order for you to be in the crossover program, you must enroll with your supplemental insurer. Once you have enrolled, Railroad Medicare will receive, on a regular basis from the supplemental insurer, a list of patients in the crossover program. Once the lists are received from the crossover companies, claim information is electronically compared with the list to determine if there is a match.

If there is a match, the information is transferred to the requesting crossover company. The information forwarded to the requesting company is similar to the information provided on a Medicare Summary Notice (MSN). If your name and health insurance claim (HIC) number appear on the list, your claims processed during that month will be forwarded to your supplemental insurer. You may be enrolled in the crossover program with more than one supplemental insurer. You can only enroll in the crossover program through your supplemental insurer, not through Railroad Medicare. Likewise, if you want to stop the crossover program, you must do this through your supplemental insurer.

If your supplemental insurance does not participate in crossover with Medicare, you will be responsible for ensuring your insurance receives information about claims Medicare has processed. Many providers will file claims to your supplemental insurance after Medicare has processed your claim. If you provider will not file to your supplemental insurance, contact the plan to verify what information they will need to process a claim. Many supplemental insurance plans will ask you to send a copy of your MSN. If you need an MSN, you may request one from our customer service unit.

If you have questions about how Medicare paid a claim as primary or secondary, please call our toll-free Customer Service Line at (800) 833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at (877) 566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours customer service representatives are available.

We encourage you to visit our website at www.PalmettoGBA.com/RR/Me and our Facebook page at www.Facebook.com/MyRRMedicare.

Palmetto GBA is reminding railroad retirees that Railroad Medicare Part B provides coverage for services such as doctors’ visits, ambulance transports, lab tests and some supplies. Benefits are the same for eligible individuals, whether eligibility is through Railroad Retirement or Social Security.

Railroad Medicare is funded by a portion of Railroad Retirement Tier I and Social Security payroll taxes paid by employees and employers. Monthly premiums are also applied to the program.

There are times when Medicare-participating providers and suppliers don’t understand that if they accept Medicare Part B, this includes Railroad Medicare too.

The Centers for Medicare and Medicaid (CMS) has incorporated information about Railroad Medicare in its online manual publications pertaining to Medicare Policy and Regulation. The CMS manual states:

“Carrier jurisdiction claims for individuals who are QRRBs (Qualified Railroad Retirement Beneficiaries), including those who are entitled to both Social Security and Railroad Retirement benefits, are handled by the Palmetto Government Benefits Administrators (GBA) L.L.C., a subsidiary of Blue Cross and Blue Shield of South Carolina.”

The CMS also includes information about Railroad Medicare in its annual Medicare & You booklet mailed to Medicare patients every year.

When Palmetto GBA conducts educational events or speaks one-on-one with providers and suppliers, they always explain what Railroad Medicare is and confirm that Medicare Part B benefits are standard nationwide.

If a provider or supplier you want to work with participates in Medicare, but states “not Railroad Medicare,” Palmetto GBA recommends that they call Palmetto’s Provider Contact Center at (888) 355-9165. Palmetto’s staff is trained to discuss these matters with all Part B providers and suppliers. They also recommend providers or suppliers visit Palmetto’s website at www.PalmettoGBA.com/RR.

If you have questions about your Part B coverage, call Palmetto’s Beneficiary Contact Center at (800) 833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET.

Palmetto also encourages beneficiaries to visit their website at www.PalmettoGBA.com/RR/Me and sign up for email updates. To do so, select “Email Updates” on the lower left-hand side of the web page under “Stay Connected.”

 

The head-cold and flu season is upon us, making it time to lower your risk of disease and illness by receiving a flu shot and pneumonia vaccine – and if you or your spouse is covered by Medicare, you won’t bear the cost and do not require a doctor’s referral.

The flu shot is an annual event, as the flu vaccine is formulated each flu season for the most probable flu virus.

You may only reqire one pneumonia shot in your lifetime, and if you are at least 65, have a chronic illness such as diabetes, or have a heart or lung disease, your risk of contracting pneumonia is higher.

Health care providers suggest you consult your physician about health risks and your need for these shots.

If you are a railroader and covered by Medicare, it is important that billing go to Railroad Medicare and that your Railroad Medicare card is on file.

Providers new to Railroad Medicare and those who have supplied services to Railroad Medicare patients for years may have new staff that might file your claims to the wrong Medicare contractor in error. This can happen when they don’t notice that your Health Insurance Claim Number (HICN) is different from Social Security Administration (SSA) Medicare patients. 

Because Railroad Medicare HICNs vary from the SSA Medicare format, it’s important that your provider’s staff review your card to verify the number prior to billing Railroad Medicare.

Railroad Medicare beneficiaries have the same benefits as Social Security beneficiaries, but only one national carrier — Palmetto GBA Railroad Medicare, which processes all Railroad Medicare Part B claims.

If you are concerned that your provider is having problems submitting your claim correctly, call the Palmetto GBA Beneficiary Contact Center at (800) 833-4455, or (877) 566-3572 for those with hearing impairments.

If you have non-claim specific questions about your coverage with Railroad Medicare, you may visit the “My RR Medicare” page on Facebook at www.facebook.com/myrrmedicare.