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

Those 65 and older who are citizens of the United States or who have lived there lawfully for five consecutive years or more.

Those under 65 who have certain qualifying illnesses or disabilities.

Medicare Part A

Medicare Part A covers hospitalization, skilled nursing facility care, hospice, and some home health care. Inpatient medically necessary services and equipment (nursing, semi-private room, prescription medicines, etc.) are generally covered. Hospice care is covered for those with six months or less to live. Services include doctor/nursing, hospice aide, physical/occupational therapy, prescription medicines, and caregiver respite.
Part A doesn't cover nursing home care. Coverage only applies to establishments when eating and bathing aren't the sole services provided.


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, usually, Part A and Part B coverage will be automatically added to your benefits package if you already receive Social Security or Railroad Retirement Board payments beginning on the first day of the month you turn 65.After receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months if you are under 65 and disabled, you will automatically get Parts A and B.

In either situation, you'll receive a Welcome to Medicare packet that includes your Medicare card and comprehensive information on how Medicare functions.

During your Initial Enrollment Period, you can enroll in Medicare even if you don't meet these conditions (IEP). The seven-month period known as your IEP is the time frame that starts three months before you turn 65 and ends three months after that month.

If you are eligible, you may enroll in Part A and Part B during a Special Enrollment Period following the conclusion of your IEP. You can also enroll during the Medicare General Enrollment Period (January 1 through March 31 annually), but if you do so, you could end up paying higher rates and delaying your 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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