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A Quick Medicare Overview For Residents Of Pennsylvania

Eighty Four Pennsylvania Hospital
Washington Hospital
155 Wilson Ave
Washington, PA 15301

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 Pennsylvania residents get will be similar to Medicare coverage everywhere else in the country.

Medicare Is Available To Two Groups Of People.

  • 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 a variety of qualifying home health care services as well as inpatient hospital care, skilled nursing facility care, hospice, and other services. A beneficiary's inpatient treatment will typically also be paid if it includes medically essential services and supplies (such as nurse care, a semi-private room, prescription medications, etc.).

    Hospice care is also covered if a beneficiary is determined to be terminally ill and has six months or less to live. Included are doctor and nursing services, hospice aide services, physical and occupational therapy, prescription medications, and caregiver respite care.

    Benefits from long-term nursing homes or care facilities are not covered by Part A. Only settings where aid with personal care, such as assistance with eating and washing, is one of many services provided to a recipient are covered.


    At age 65, you are automatically enrolled in free Part A coverage if you have paid Medicare taxes for at least 10 years while working (40 quarters). If your spouse is eligible for premium-free Part A benefits, you may also be eligible for premium-free benefits.
    You may also be eligible for free benefits if you or your spouse receive or are eligible to receive Social Security or Railroad Retirement. This benefit is accessible even if the spouse of the person requesting coverage is deceased or divorced. If you do not meet the work requirements, you can still enroll in Medicare Part A by paying a monthly fee.

    If you are younger than 65, you may be eligible for Medicare Part A if:

    You have end-stage renal disease (ESRD) or permanent kidney failure that requires either ongoing dialysis or a transplant.
    You receive disability benefits due to Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig's disease).
    You're a child or widow(er) age 50 or older of someone who worked in a government job long enough where Medicare taxes were paid, and you meet Social Security disability program requirements.
    If you received disability benefits due to a After receiving either of these disability benefits for a total of 24 months, you are automatically enrolled in Parts A and B. These months need not be in succession.


    In Pennsylvania, when you turn 65, if you are already receiving payments from Social Security or the Railroad Retirement Board, you will usually be enrolled in Medicare Part A and Part B automatically. If you are under 65 and disabled, you are eligible for both Part A and Part B of Medicare after 24 months of receiving disability benefits from Social Security or the Railroad Retirement Board.

    In either event, you should expect to get a Welcome to Medicare packet that contains your Medicare card and detailed information on the program. During the Initial Enrollment Period, you can enroll in Medicare even if you don't match these criteria (IEP). The seven-month Individualized Education Plan (IEP) period begins three months before to the month you turn 65 and ends three months following the month you turn 65.

    If you are eligible, you can enroll in Medicare Parts A and B during a Special Enrollment Period after your IEP ends. During the Medicare General Enrollment Period (January 1 through March 31 each year), you can also enroll, although doing so may result in higher rates and a delay in coverage.


    Other than hospitalization costs, Part A coverage is free for those who qualify. If you do not qualify for free Medicare Part A coverage, you may still enroll and pay a premium if you meet one of the following conditions:

    You are at least 65 years old.
    You are enrolled or in the process of enrolling in Medicare Part B.
    You meet the citizenship and residency requirements.

    The amount of your premiums will vary based on the number of years you've worked and how close you are to earning 40 Social Security credits. In most situations, if you enroll in and pay for Medicare Part A, you must also enroll in and pay for Medicare Part B.

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

    When it comes to deciding on the right health-care plan for you and your family, an insurance broker's knowledge can be invaluable.  An insurance broker can help you with every aspect of a health insurance plan purchase.  An Medicare insurance broker can expertly explore the benefits and drawbacks of any plan you are considering.

    Speaking with a health insurance representative is a natural first step you should take before obtaining a health plan.  Best of all, assistance from a health insurance broker is usually free.

    Good to know:  When it comes to medical services, shop around for a better deals.  Patients often think that medical fees are set, but just like any other business, costs for goods and services can vary widely.  Shop the cost of exams, tests, procedures, medications, nursing facilities, and imaging centers before non-emergency events.  The price of an MRI on one side of Main Street can be $500, and $2,500 on the other.  Healthcare pricing, as a rule, is arbitrary.  Even the pharmacy you choose can be the difference in hundred of dollars annually.

    We provide instant health insurance quotes, comparisons, and plan benefit details from the top health insurance carriers.  Our services are free.  724-884-1496
    Choosing a health insurance plan is not something to take "lightly".  We can assist.

    We understand how difficult it can be to choose the best plan for you and your family's needs.  Plan benefits, physician networks, deductibles, Rx coverage, and other components of a health insurance plan, should all be carefully considered.

    Our licensed Medicare insurance professionals are happy to assist in sorting through all of the details in order to acquire a quality, affordable health insurance plan that meets the needs of you and your family.  Our services are free.  call now.    724-884-1496

    Marley Financial Group    724-884-1496
    Innovative Solutions      Get An Instant Quote Now