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A Brief Description Of Medicare For Residents Of California


West Hollywood California Hospital
Cedars Sinai Medical Center
8730 Alden Dr # 2E
Los Angeles, CA 90048
Plus code: 3JG9+26 Los Angeles, California




The Centers for Medicare & Medicaid Services handle Medicare, a federal health insurance program. There are some slight variances across states, but the vast majority of Medicare is the same throughout the United States, so the coverage California people receive will be comparable to Medicare coverage across the country.


Medicare Is Available To Two Groups 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

    Those who paid Medicare taxes while employed for at least ten years are automatically enrolled in free Part A coverage when they turn 65. (40 quarters). You might be eligible for premium-free Part A benefits if your spouse is. If they are, then you might be as well. If you or your spouse are currently receiving or are eligible for Railroad Retirement benefits, you may also be eligible for free benefits. Even if the applicant's spouse passed away or got divorced, this benefit is still available.
    Even if you don't have a job, you can still enroll in Part A, but you'll have to pay a monthly premium.

    In order to be eligible for Medicare Part A benefits if you are under 65, you must:

    Meet the requirements for the Social Security disability program. You may be eligible if you have end-stage renal disease (ESRD) or permanent kidney failure that necessitates ongoing dialysis or a transplant, receive disability benefits due to Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig's disease), are the child or widow(er) of a worker who worked in a government job for a sufficient amount of time to have paid Medicare taxes, are 50 years of age or older, After receiving one of these disability benefits for 24 cumulative months, you are automatically enrolled in Parts A and B. These months don't have to be one after the other.


    Enrollment

    In California, if you are already receiving Social Security or Railroad Retirement Board benefits, you will typically receive Part A and Part B coverage on the first day of the month you turn 65. If you are under 65 and disabled, you are automatically enrolled in Medicare Parts A and B after 24 months of receiving disability benefits from Social Security or the Railroad Retirement Board.

    In either instance, you will receive a Welcome to Medicare packet containing your Medicare card and comprehensive information on how Medicare operates.

    You can enroll in Medicare during the Initial Enrollment Period if you do not meet these conditions (IEP). Your IEP is the seven-month period beginning three months before your 65th birthday and ending three months after it. If you qualify, you may enroll in Medicare Parts A and B during a Special Enrollment Period following the conclusion of your IEP. You may also enroll during the Medicare General Enrollment Period (January 1 through March 31 each year), but this may result in higher costs and delayed coverage.


    Costs

    If you are eligible, Medicare Part A coverage is provided at no cost to you, with the exception of hospital deductibles. Those who do not meet the criteria for no-cost Part A coverage may nonetheless enroll and pay a premium under the following conditions:

    You are at least 65 years old.
    You have or are in the process of obtaining Medicare Part B coverage.
    You are a citizen or permanent resident of the United States.

    In order to qualify for Social Security benefits, you need to earn at least 40 credits, and the premium you pay will change based on how close you are to that threshold.

    If you sign up for and pay for Medicare Part A, you will almost always have to sign up for and pay for Medicare Part B as well.


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




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    Interesting Fact:  Medicare and Medicaid in America account for more than 1 of every 3 dollars spent on American health care, and 1 of every 4 dollars in the federal budget.  What is astounding is the fact that the cost of Medicare is still growing.  Currently, the cost is growing at more than twice the rate of inflation.  This growth curve is expected to become even more dramatic as the baby boomers age.

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    Campanelli Insurance Services   (424) 257-3314
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