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.


Eligibility

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.


Enrollment

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.


Costs

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.




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