The Centers for Medicare & Medicaid Services administers Medicare, a federal health insurance program. There are some slight variances across states, but the vast majority of Medicare is the same across the country, so the coverage California people receive will be similar to Medicare coverage across the country.


Two Categories Of Individuals Are Eligible For Medicare.

People 65 and older who are American citizens or have been legal permanent residents of the United States for at least five years.

People under the age of 65 who have specified qualifying medical conditions 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

If you have worked and paid Medicare taxes for at least 10 years prior to turning 65, you will have free coverage under Part A automatically enrolled for you (40 quarters). If your spouse is eligible for Medicare Part A benefits without having to pay a premium, then you may also be qualified for these benefits without having to pay a premium if you meet the requirements.
You or your spouse may be eligible for free benefits if either of you receives, or is eligible to receive, Social Security or Railroad Retirement benefits, or if either of you receives benefits from those programs. This benefit is still accessible even if the spouse of the individual seeking coverage has passed away or the couple has split.
You are still able to sign up for Medicare Part A even if you do not meet the work requirements; however, you will be required to pay a monthly payment.

If you're under age 65, you can qualify for Medicare Part A coverage if:

You have end-stage renal disease (ESRD) or permanent kidney failure that requires either ongoing dialysis or a transplant.
You receive disability benefits because you have amyotrophic lateral sclerosis (ALS/Lou Gehrig's disease).
You are the child or widow(er) of someone who worked in a government job long enough where they paid Medicare taxes, and you meet the requirements for the Social Security disability program.
You are eligible if you received a disability award from the Department After receiving either of these types of disability benefits for a total of 24 months, you are qualified for automatic enrollment in Medicare Part A and Part B. It is not necessary for these months to be in consecutive order.


Enrollment

In California, usually, Part A and Part B coverage will begin on the first day of the month you turn 65 if you already get Social Security or Railroad Retirement Board benefits. If you are disabled and under 65, you will automatically get Parts A and B after 24 months of receiving disability benefits from the Railroad Retirement Board or Social Security.

You'll receive a Welcome to Medicare packet in both situations, which includes your Medicare card and comprehensive information about how Medicare functions.

You can enroll in Medicare during your Initial Enrollment Period even if you don't match these criteria (IEP). Your IEP is the seven-month term that starts three months prior to the month you turn 65 and ends three months thereafter.

If you're eligible, you can enroll in Part A and Part B during a Special Enrollment Period after your IEP expires. You can also enroll during the Medicare General Enrollment Period (which runs from January 1 through March 31 each year), but doing so could result in higher rates and a longer wait for coverage.


Costs

With the exception of some hospital stay deductibles, Part A coverage is free if you qualify. If you are not eligible for free Part A coverage, you may still sign up and pay a premium if you meet the following criteria:

You must meet certain citizenship and residency requirements, be 65 years old or older, and be enrolled in Medicare Part B coverage or in the process of doing so.

The amount of your premium will change based on how long you have worked and how close you are to reaching the required 40 Social Security credits.

In most circumstances, enrolling in and paying a separate premium for Medicare Part B is required if you want to pay for Medicare Part A.


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




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