Medicare Part A

Medicare is a low-cost federal health insurance program available to people who are 65 years of age or older, people with permanent kidney damage, and certain younger people living with disabilities. California has many beneficiaries of Medicare, and there are many programs that offer assistance concerning Medicare here in California. Medicare has several parts that cover different types of services. Here, we’ll focus on Medicare Part A.

 What is Medicare Part A?

This is also known as hospital insurance, in simple terms. You can use it with any doctor or hospital that accepts it anywhere in the US. It covers four things:

• Skilled care in a nursing facility
• Most inpatient hospital stays
• Hospice care
• Homecare in some cases

If you have been paying Medicare payroll taxes for about ten years while working, or have received railroad benefits, Medicare Part A is usually free and it’s called premium-free Part A. If you don’t qualify for this, you pay premiums for it, and it’s called premium Part A.

Who Can Enroll IN MEDICARE PART A?

If you’re over 65 years old, or are turning 65 in the next 3 months and are not already getting benefits from social security, you won’t get Medicare automatically. You need to register for it. If you have similar age circumstances as those above and you get benefits from social security, you don’t have to register for either Medicare program. You’ll get it automatically, and Medicare will send you a welcome package.

If you live in Puerto Rico, you only get Part A, and you need to register for Part B if you want it.

How Do I Enroll In Medicare Part A?

Contact us here to sign up for Medicare Part A. We will review your situation with you to see if you qualify for Medicare, including details like if you have to pay premiums for Part A and the exact date when the coverage will actually start for you.

When CAN I Enroll For Medicare Part A?

Initial Enrollment Period

When you qualify for Medicare, there is a 7-month period to sign up for either Part A or B or both and this is known as the initial enrollment period. This period begins 3 months prior to your 65th birthday and it includes the month of your birthday and ends 3 months after your 65th birthday. If you’re not automatically enrolled for Medicare, you can get registered for free Part A (if you qualify for it), anytime during the initial period.

General Enrollment Period

This is the period that starts on January 1 and ends on March 31. If you want to apply for Part A or B during this time period, you need to fulfill the following criteria;

• You failed to enroll during the initial enrollment when you first became eligible.
• You are not eligible for the special enrollment period.

If you enroll during this time for either of the above reasons, you have to pay premiums, which may be higher due to late enrollment. Another point to remember is that the coverage will start on July 1.

Special Enrollment Period

If you didn’t register for the program during the initial period, there is still a chance to enroll for it during the special enrollment. However, there are some conditions to meet, which include;

• The person who is applying or their spouse (or family member for people living with disabilities is currently working.
• The applicant is covered by another health plan via the union or employer based on that work.

The 8-month special enrollment period is for Part A and it starts the month after your employment ends or the month after your group health plan based on your employment ends, whichever comes first. There is no need to pay a late enrollment penalty if you sign up during this time.

If you’re serving as a volunteer in a foreign country, you may also be eligible for the special enrollment period.

Frequently Asked Questions

When do I get my Medicare Card?

Your card will come in the mail about 2 weeks after you enroll and it is included in your “Welcome to Medicare” packet. If you don’t receive it within that time, check to see if you submitted the right mailing address.

Do I need to register for Medicare each year?

No, you don’t, as long as you continue to pay premiums (if necessary). You can, however, review your coverage and change plans if the need arises. Contact us for more information.

What if my doctor stops accepting Medicare?
If your doctor no longer accepts Medicare payment, you will need to pay out-of-pocket, or look for another Medicare doctor.

Does Medicare cover all my medical costs?
It does not cover 100% of medical costs, and the California Department of Insurance (CDI) recommends that you purchase a Medicare Supplement Insurance (or Medigap) to cover costs not covered by Medicare. Contact us for more information.

What if I lose or damage my Medicare Card?
If your card gets damaged, lost, or stolen, you can request a replacement. If you need assistance, please call us and we can assist you. Your new card will be mailed to you within 30 days.

Do I need to submit a claim bill to Medicare?
No, you don’t. The providers should file Medicare claims for the covered services you get within one full calendar year following the year in which the services were provided. If the claim isn’t filed within this limit, Medicare may decline to pay its share. If your claims are not being filed, contact your medical supplier and find out why, or call Medicare and inform them. You can also just file the claim yourself by submitting the Patient Request for Medicare Payment form.