The Centers for Medicare & Medicaid Services oversee the Medicare health insurance program. Medicare coverage in Delaware is similar to Medicare coverage in the rest of the United States, with some small changes due to legal requirements.


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 inpatient hospital treatment, skilled nursing facility care, hospice care, and certain types of qualifying home health care. Nursing services, a semi-private room, prescription medications, and other medically essential services and equipment are normally reimbursed if part of a beneficiary's inpatient treatment.

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

Part A does not provide benefits for long-term nursing homes or care facilities. Coverage is limited to institutions where support with personal care, such as eating and bathing, is not the only aid provided to a beneficiary.


Eligibility

If you have worked and paid Medicare taxes for at least 10 years prior to turning 65, you will have free coverage under Part A automatically enrolled for you (40 quarters). If your spouse is eligible for Medicare Part A benefits without having to pay a premium, then you may also be qualified for these benefits without having to pay a premium if you meet the requirements.
You or your spouse may be eligible for free benefits if either of you receives, or is eligible to receive, Social Security or Railroad Retirement benefits, or if either of you receives benefits from those programs. This benefit is still accessible even if the spouse of the individual seeking coverage has passed away or the couple has split.
You are still able to sign up for Medicare Part A even if you do not meet the work requirements; however, you will be required to pay a monthly payment.

If you're under age 65, you can qualify for Medicare Part A coverage if:

You have end-stage renal disease (ESRD) or permanent kidney failure that requires either 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 where they paid Medicare taxes, and you meet the requirements for the Social Security disability program.
You are eligible if you received a disability award from the Department After receiving either of these types of disability benefits for a total of 24 months, you are qualified for automatic enrollment in Medicare Part A and Part B. It is not necessary for these months to be in consecutive order.


Enrollment

In Delaware, if you are already receiving Social Security or Railroad Retirement Board benefits, you will receive Part A and Part B coverage the first day of the month in which you turn 65.

Receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months qualifies you for Part A and Part B automatically if you are under 65 and disabled.

In either case, you will receive a Welcome to Medicare package containing your Medicare card and detailed information on how Medicare operates. If you do not fulfill these criteria, you may enroll in Medicare during your Initial Enrollment Period (IEP). Your IEP is the seven-month period beginning three months prior to the month you turn 65 and ending three months after 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 expires. You may also enroll during the Medicare General Enrollment Period (January 1 through March 31 each year), but this may result in higher rates and a delay in coverage.


Costs

If you qualify, Part A coverage is free, but you may have to pay deductibles for hospital stays.If you don't qualify for free Part A coverage, you can still sign up and pay a premium if you meet the following conditions:

You are at least 65 years old.
You are enrolled in or in the process of enrolling in Medicare Part B coverage.
You meet citizenship and residency requirements. The cost of your premium will depend on how long you have worked and how close you are to getting the minimum of 40 Social Security credits.

Most of the time, if you enroll in and pay for Medicare Part A, you must also enroll in and pay a separate premium for Medicare Part B.


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




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