The Three Most Important Railroad Medicare Forms


When interacting with Railroad Medicare, there are three forms that can simplify the process.  These forms allow you to update your information that we have on file, as well as allow Palmetto GBA to release your personal information to one or more individuals that you designate.

The Beneficiary Address Change Form
If you need to update your address with Railroad Medicare and/or the Railroad Retirement Board, use our Beneficiary Address Change Form.  Palmetto GBA has designed this interactive form to be completed easily and quickly. If someone else is sending this form on your behalf, they must include a copy of legal or court papers showing that you’ve authorized them to do so. 

The Beneficiary Authorization Form (PDF, 292 KB)
Medicare cannot release specific information about your benefits or claims to someone else, including your spouse, without your verbal or written permission.  If your spouse or someone else may be contacting Medicare for you on a regular basis, you might consider sending written permission for them.  The Beneficiary Authorization Form is used to indicate who you would like to have access to your Medicare claims and benefits information.  Once we’ve received the completed form, we’ll document on your records any individual you’ve given consent to and send you an acknowledgment letter.

We may also accept a copy of a valid Power of Attorney document to list someone as authorized on your account. If you choose to send a Power of Attorney (POA) document to our office, it must include your name and address, the name and address of the person appointed as your representative, your signature and the date you signed the document. The document must also indicate that it allows your representative to assist you with health insurance and medical issues.  If your state laws require the document to have a court or notary seal, the seal must be visible on the copy. Please also include your Medicare number and date of birth. 

The Deceased Beneficiary Address Change Form (PDF, 688 KB)
If, after the death of a Railroad Medicare beneficiary, the address on file needs to be changed (as an example, the address for the patient was a nursing home, but the patient’s representative needs to change the address to their home in order to handle outstanding claims), then this is the form to use.   To allow us to take action, the form must include a copy of the court papers naming the form submitter as the estate representative. Examples of acceptable documentation include:

  • Executor/Executrix papers
  • Next of kin attested by court documents with a court stamp and a judge's/clerk of court's signature
  • A Letter of Testamentary or Administration with a court stamp and judge's/clerk of court's signature,
  • Personal representative papers with a court stamp and judge's/clerk of court's signature.

Unfortunately, Railroad Medicare is unable to accept a copy of a will or other legal documentation drawn prior to a patient’s death. If the person submitting this form doesn’t have court papers naming them as the estate representative, Railroad Medicare will temporarily update the address for a period of 12 months.

All forms are located on our website at www.PalmettoGBA.com/RR/Me under the 'Resources' link in the 'Topics' box on the site. 

If you have questions about these forms or how to complete them, please call our Beneficiary Contact Center at 800-833-4455, between 8:30 a.m. and 7 p.m. ET. We encourage you to also visit our Facebook page called 'My RR Medicare' at www.facebook.com/MyRRMedicare.



Last Updated: 03/07/2018