10 Railroad Medicare Truths That Can Derail Railroaders

10 Key Medicare Tips Every Railroader Needs to Know

Welcome, everyone, to another edition of the Highball Advisors Railroad Retirement Whiteboard. I'm John McNamara of Highball Advisors, and today we're diving into a topic that comes up a lot: Medicare—specifically Railroad Medicare, though much of what we’ll cover applies to Medicare in general.

This is especially important for railroaders who retire early, maybe at 60 with a 30-year career. You’ve probably heard people say, “Once I get to Medicare, I’ll be fine.” Well, yes and no. There are several key things you need to understand so you’re not caught off guard.

I’ve outlined 10 important Medicare facts you should be aware of—especially as you build that bridge from retirement to Medicare. Let’s go through them at a high level:

1. Medicare Isn't Free

Many people think, “I made it to Medicare—no more health insurance costs!” But that’s not quite true.

• Part A is generally free.
• Part B has a monthly premium, and if you choose a supplement plan or Medicare Advantage, there could be additional costs.
   You still need to budget for healthcare in retirement.

2. You're Not Automatically Enrolled

If you’re still working and have health insurance, you likely won’t be automatically enrolled. However, if you’re collecting Railroad Retirement benefits and turn 65, you will be enrolled automatically. Be sure to understand your individual situation.

3. There Are Penalties for Late Enrollment

Don’t delay! There are penalties for enrolling late in Parts A, B, and D (especially Part D for prescription drugs). Trying to save by waiting to enroll can backfire. Late enrollment penalties can last a lifetime.

4. Medicare Doesn’t Cover Everything

Original Medicare doesn’t cover:

• Vision
• Dental
• Hearing
• Travel outside the U.S.

You may need additional plans or a Medicare Advantage plan to fill these gaps.

5. Medicare Doesn’t Cover Long-Term Care

This is a big one. Medicare only covers short-term stays in skilled nursing facilities (about 90 days). Long-term care, like assisted living or nursing homes, is not covered—and it can be a major expense in retirement.

6. Your Income Affects Your Medicare Premiums

Enter the IRMAA (Income-Related Monthly Adjustment Amount). Higher retirement income can lead to higher premiums for Parts B and D. This is why retirement income planning—especially drawing down from your 401(k)—needs to factor in IRMAA thresholds.

7. It’s Not “Set It and Forget It”

Just because you’ve enrolled at 65 doesn’t mean you’re done.

• You may develop new health needs.
• You might move to a new state with different coverage options.

Review your Medicare plan every year to ensure it still fits your situation.

8. Medicare Isn’t Family Coverage

Unlike railroad health plans that cover the whole family, Medicare is individual-only. If your spouse is under 65, they’ll need to find separate insurance.

9. Medicare Doesn’t Cover You Abroad

Thinking about retiring in Thailand, Portugal, or Costa Rica? Original Medicare does not offer coverage outside the U.S. You’ll need to consider international health insurance, Medigap with limited travel coverage, or other options.

10. Dental Coverage is Not Included

Original Medicare doesn’t cover dental care. You’ll need separate dental insurance or a Medicare Advantage plan that includes it. Just be cautious: Medicare Advantage plans can be restrictive—read the fine print, because once you enroll, switching back isn’t always easy.

Final Thoughts

These are the kinds of important considerations I go over in my “Boarding for Railroad Retirement” planning sessions. If you’re approaching retirement, or already retired and thinking about Medicare, make sure you’re fully informed and prepared.

Share this video with any railroaders you know who are near retirement—no one likes surprises, especially when it comes to healthcare.

And don’t forget to click the notification bell to stay updated. As always, stay safe, stay on track, and take care. So long, everybody!

Get Free Railroad Retirement Assessment

Disclaimer: This article is provided for general information and illustration purposes only. Nothing contained in the material constitutes tax advice, a recommendation for purchase or sale of any security, or investment advisory services. Highball Advisors encourages you to consult a financial planner, accountant, and/or legal counsel for advice specific to your situation. Reproduction of this material is prohibited without written permission from Highball Advisors, and all rights are reserved from Highball Advisors, and all rights are reserved.