Question 279: We are trying to assist someone who has Medicare through Railroad Retirement. She has the Secure Horizions Plan and can't seem to get a straight answer about her benefits-- in particular, how much Secure Horizions will pay. Can you give us any information so we can explain the situation to her?
Answer: Railroad Retirement beneficiaries receive Medicare benefits under the same conditions as those covered by Social Security. Regular Part A (hospital) claims are processed by the same intermediaries as those involving Social Security beneficiaries. Part B (doctor and provider) claims are processed by a special Part B carrier selected by the RRB. The current Part B carrier for Railroad Retirement Medicare is Palmetto GBA, P.O. Box 10066, Augusta GA 30999. Their toll free number is (800) 833-4455, Monday through Friday, 9 am - 5:15 pm Eastern time.
The overall Medicare program is the responsibility of the Centers for Medicare & Medicaid Services (CMS), Department of Health & Human Services. The Railroad Retirement Board is responsible for the performance of Palmetto GBA.
Secure Horizons offers a comprehensive managed care plan for Medicare beneficiaries (including Railroad Retirement) that offers benefits above those available in the traditional Medicare Parts A and B. It also operates supplemental Medicare plans for those individuals with traditional Medicare coverage.
From your question, I really can't tell if your client has Medicare+Choice or traditional Medicare with a supplemental policy from Secure Horizions. If she has Medicare+Choice, Secure Horizions is responsible for providing all of her Medicare benefits. She would have to follow their rules for securing benefits by first using their desiginated providers for routine care before she can be referred by the plan to a specialist for treatment. Any questions or problems need to be addressed to Secure Horizions (see their website at www.securehorizions.com). If they do not resolve the situation, then CMS should be contacted.
If she has traditional Medicare supplemented by Secure Horizions, the Part A intermediary and the Part B carrier (Palmetto GBA) need to first pay the Medicare benefits. Then Secure Horizions would pay additional amounts due under the supplemental policy.