The Centers for Medicare & Medicaid Services (CMS) run the Medicare health insurance program on behalf of the federal government. The Medicare coverage that South Carolina residents receive will be largely similar to the Medicare coverage that is provided throughout the United States, with a few small exceptions.


Medicare Is Open To Two Categories Of People

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

Individuals under the age of 65 with certain 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 paid Medicare taxes for at least ten years while working, you are automatically enrolled in free Part A coverage at the age of 65. (40 quarters). If your spouse is eligible for Part A coverage without paying a premium, you may be eligible as well.
You may also be eligible for free benefits if you or your spouse receive or are eligible for Social Security or Railroad Retirement payments. This benefit is provided even if the person requesting coverage's spouse is deceased or divorced. If you do not meet the work criteria, you can still enroll in Part A, but you must pay a monthly premium.

If you are under the age of 65, you may be eligible for Medicare Part A coverage if you meet the following criteria:

You have end-stage renal disease (ESRD) or permanent kidney failure that necessitates 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 to pay Medicare taxes and you meet Social Security disability program requirements
After receiving either of these disability benefits for a total of 24 months, you are automatically enrolled in Parts A and B. These months do not have to be in any particular order.


Enrollment

In South Carolina, if you are already receiving payments from Social Security or the Railroad Retirement Board, then in the vast majority of cases, you will automatically be enrolled in Medicare Part A and Part B coverage beginning on the first day of the month in which you reach 65 years old.

After receiving disability benefits from Social Security or the Railroad Retirement Board for a period of 24 months, you will be eligible for automatic enrollment in Medicare Parts A and B if you are under the age of 65 and disabled.

In either scenario, you will receive a Welcome to Medicare packet that contains your Medicare card as well as comprehensive information regarding the operation of Medicare.

In the event that you do not satisfy these prerequisites, you still have the opportunity to enroll in Medicare during your Initial Enrollment Period (IEP). Your Individualized Education Program (IEP) spans the seven months that begin three months before the month in which you turn 65 and end three months following the month in which you turn 65.

If you are eligible, you will be able to enroll in Medicare Part A and Part B during a Special Enrollment Period at the conclusion of your IEP. You can also sign up for Medicare during the General Enrollment Period, which runs from the first of the year until the thirty-first of the following month. If you choose this option, however, you may be subject to higher rates and a delay in coverage.


Costs

Except for some hospital stay expenses, Part A coverage is free if you meet the requirements. The following conditions must be met in order to enroll and pay a premium even if you are not eligible for free Part A coverage:

You meet citizenship and residence requirements.
You are 65 years of age or older
You have enrolled in Medicare Part B coverage or are in the process of doing so.

In most situations, if you sign up for and pay for Medicare Part A, you also need to sign up for and pay for Medicare Part B separately.


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




Now that you are armed with information, contact a local Medicare health insurance broker.  When it comes to selecting the best health care plan for you and your family, the expertise an insurance broker can provide is essential.  A good Medicare insurance broker can assist you with every part of the health insurance plan buying process.  They can review and discuss with you the advantages and disadvantages of plans your are considering.

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