Medicare is a federal health insurance program that is run by the Centers for Medicare & Medicaid Services. There are some small differences from state to state, but most of Medicare is the same everywhere in the U.S., so the coverage California residents get will be similar to Medicare coverage everywhere else in the country.


Medicare Is Available To Two Groups Of People.

Individuals 65 and older who are citizens of the United States or who have lived in the country legally for at least five years straight.

Individuals younger than 65 with certain qualifying illnesses or disabilities.

Medicare Part A

Part A, generally known as Medicare hospital insurance, covers inpatient hospital treatment, skilled nursing facility care, hospice care, and certain types of qualifying home health care. Nursing services, a semi-private room, prescription medications, and other medically essential services and equipment are normally reimbursed if part of a beneficiary's inpatient treatment.

Hospice care is also covered if a beneficiary is diagnosed with terminal illness and has six months or less to live. Included are doctor/nursing services, hospice aide services, physical/occupational therapy, prescription medicines, and caregiver respite care.

Part A does not provide benefits for long-term nursing homes or care facilities. Coverage is limited to institutions where support with personal care, such as eating and bathing, is not the only aid provided to a beneficiary.


Eligibility

Those who paid Medicare taxes while employed for at least ten years are automatically enrolled in free Part A coverage when they turn 65. (40 quarters). You might be eligible for premium-free Part A benefits if your spouse is. If they are, then you might be as well. If you or your spouse are currently receiving or are eligible for Railroad Retirement benefits, you may also be eligible for free benefits. Even if the applicant's spouse passed away or got divorced, this benefit is still available.
Even if you don't have a job, you can still enroll in Part A, but you'll have to pay a monthly premium.

In order to be eligible for Medicare Part A benefits if you are under 65, you must:

Meet the requirements for the Social Security disability program. You may be eligible if you have end-stage renal disease (ESRD) or permanent kidney failure that necessitates ongoing dialysis or a transplant, receive disability benefits due to Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig's disease), are the child or widow(er) of a worker who worked in a government job for a sufficient amount of time to have paid Medicare taxes, are 50 years of age or older, After receiving one of these disability benefits for 24 cumulative months, you are automatically enrolled in Parts A and B. These months don't have to be one after the other.


Enrollment

In California, if you already get Social Security or Railroad Retirement Board benefits, you will usually receive Part A and Part B coverage on the first of the month you turn 65. If you are under the age of 65 and handicapped, you will automatically get Part A and Part B after earning Social Security or Railroad Retirement Board disability benefits for 24 months.

In either event, you'll receive a Welcome to Medicare packet that includes your Medicare card and detailed information about how Medicare works. If you do not fulfill these criteria, you can enroll in Medicare during your Initial Enrollment Period (IEP). Your IEP is a seven-month period that begins three months before your 65th birthday and concludes three months after your 65th birthday.

If you qualify, after your IEP, you can sign up for Part A and Part B during a Special Enrollment Period. You can also join up during the Medicare General Enrollment Period (January 1 through March 31 each year), although this choice may result in higher costs and delayed coverage.


Costs

If you qualify, Part A coverage is free, but you may have to pay deductibles for hospital stays.If you don't qualify for free Part A coverage, you can still sign up and pay a premium if you meet the following conditions:

You are at least 65 years old.
You are enrolled in or in the process of enrolling in Medicare Part B coverage.
You meet citizenship and residency requirements. The cost of your premium will depend on how long you have worked and how close you are to getting the minimum of 40 Social Security credits.

Most of the time, if you enroll in and pay for Medicare Part A, you must also enroll in and pay a separate premium for Medicare Part B.


Upcoming Article: Understanding Medicare Part B, C, and D.




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