RevealingMedicare Enrollment: Coverage and Eligibility Explained
What is Original Medicare, who qualifies, and more importantly, are you eligible for Medicare coverage?
Although the Medicare program has evolved since it first started in 1965, Original Medicare is the single payer, Federal health insurance program for U.S. citizens and legal residents age 65 or older. It now also includes coverage for individuals eligible for Social Security Disability benefits, those who have kidney failure, or ALS (Lou Gehrig’s disease). There is one other Federal insurance payer, the Federal Employees Health Benefits program that covers Federal employees.
Original Medicare coverage includes medical insurance that covers visits to doctors, Medicare supplies and equipment, hospital outpatient care, and many other medical services, such as labs, radiology, and physical therapy. This is the Part B side of Medicare. The Part A of Medicare helps pay for inpatient services. Part A would include coverage for inpatient hospital days, skilled nursing facility stays, and Home Health benefits.
Generally speaking, eligibility is not complicated. If you are a U.S. Citizen or naturalized citizen nearing the age of 65, or disabled or have End Stage Renal Disease, you are probably eligible. Eligibility questions, however, can be addressed to the Social Security Administration at 1-800-772-1213.
If you have elected to start receiving Social Security benefits prior to turning age 65, then your enrollment into Medicare Part A and Part B will be automatic. In your case, about 3 months before your sixty-fifth birthday, you will receive an initial enrollment packet including your Medicare card.
Those of you nearing 65 and still working or simply choosing to put off receiving Social Security benefits will need to apply directly with the Social Security Administration. The time to do this is during the Initial Open Enrollment Period, which begins 3 months before your sixty-fifth birth day, and ends 3 months after the month of the sixty-fifth birthday.
The one stable piece of information to hold onto is that Medicare enrollment is always done through the Social Security Administration. If you are already receiving benefits, your enrollment will be automatic and you won’t need to do anything at all. If you are not receiving SSA benefits by your sixty-fifth birthday, you will need to submit an application through the Social Security Administration. As this is quite an important change in your life, you should not hesitate to seek answers to your questions through the Social Security Administration toll free number, 1-800-772-1213.
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