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A Brief Summary Of Medicare Benefits For Residents Of South Carolina


Aiken South Carolina Hospital
Aiken Regional Medical Center
302 University Pkwy
Aiken, SC 29801




The Centers for Medicare & Medicaid Services administers Medicare, a federal health insurance program. There are some slight variances across states, but the vast majority of Medicare is the same across the country, so the coverage South Carolina people receive will be similar to Medicare coverage across the country.


Two Categories Of Individuals Are Eligible For Medicare.

  • 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, generally known as Medicare hospital insurance, covers a variety of qualifying home health care services as well as inpatient hospital care, skilled nursing facility care, hospice, and other services. A beneficiary's inpatient treatment will typically also be paid if it includes medically essential services and supplies (such as nurse care, a semi-private room, prescription medications, etc.).

    Hospice care is also covered if a beneficiary is determined to be terminally ill and has six months or less to live. Included are doctor and nursing services, hospice aide services, physical and occupational therapy, prescription medications, and caregiver respite care.

    Benefits from long-term nursing homes or care facilities are not covered by Part A. Only settings where aid with personal care, such as assistance with eating and washing, is one of many services provided to a recipient are covered.


    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

    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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