The Centers for Medicare & Medicaid Services (CMS) run the Medicare health insurance program on behalf of the federal government. The Medicare coverage that Texas 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

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

Part A, often known as Medicare hospital insurance, normally covers inpatient hospital treatment, skilled nursing facility care, hospice care, and certain home health care services that qualify. Medically essential services and equipment (e.g., nursing services, a semi-private room, prescription medicines, etc.) that are part of a beneficiary's inpatient treatment are typically covered as well.

Hospice care is also covered if a beneficiary is diagnosed with a terminal illness and has less than six months to live. Included are physician/nursing services, hospice aide services, physical/occupational therapy, prescription medicines, and caregiver respite care.

Part A does not cover long-term care institution or nursing home benefits. Only facilities where support with personal care, such as eating and bathing, is not the only aid a beneficiary receives are covered.


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 Texas, when you turn 65, if you are already receiving payments from Social Security or the Railroad Retirement Board, you will usually be enrolled in Medicare Part A and Part B automatically. If you are under 65 and disabled, you are eligible for both Part A and Part B of Medicare after 24 months of receiving disability benefits from Social Security or the Railroad Retirement Board.

In either event, you should expect to get a Welcome to Medicare packet that contains your Medicare card and detailed information on the program. During the Initial Enrollment Period, you can enroll in Medicare even if you don't match these criteria (IEP). The seven-month Individualized Education Plan (IEP) period begins three months before to the month you turn 65 and ends three months following the month you turn 65.

If you are eligible, you can enroll in Medicare Parts A and B during a Special Enrollment Period after your IEP ends. During the Medicare General Enrollment Period (January 1 through March 31 each year), you can also enroll, although doing so may result in higher rates and a delay in coverage.


Costs

If you qualify, Part A is free, with hospital deductibles. If you don't qualify for free Part A, you can still pay a premium if:

You're 65 or older.
You have Medicare Part B coverage.
You meet citizenship and residence requirements.

Premium prices vary on how long you've worked and how close you are to 40 Social Security credits.

Most people who enroll in Medicare Part A must also enroll in Part B and pay a separate premium.


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




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