The Centers for Medicare & Medicaid Services are in charge of managing the federal health insurance program known as Medicare. While there are a few minor variations from state to state, Medicare is largely the same across the country, thus the coverage received by residents of South Carolina will be quite similar to Medicare coverage across the country.


Medicare Is Open To Two Categories 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

Medicare Part A, generally known as hospital insurance, pays for a variety of medical services that cannot be provided outside of a hospital, such as stays in a nursing home or hospice care. The cost of a beneficiary's inpatient stay, including any medically necessary services and supplies (such as nursing care, a semi-private room, medication, etc.), is typically covered by insurance.

When a patient has been given a terminal illness prognosis of six months or fewer to live, hospice care is also covered. Medical and nursing care, hospice care, rehabilitative treatments, medication, and breaks for primary caregivers are all covered.

Medicare does not pay for long-term care in a nursing home under Part A. Facilities where the only support a recipient receives is with activities of daily living, such as eating and bathing, are not 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 South Carolina, 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

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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