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What is Original Medicare, who qualifies, and more importantly, are you eligible for Medicare coverage?

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.

So, how do you know if you eligible for Medicare? If you are a U.S. citizen or naturalized citizen and you fall into one of the categories above (65 or over, disabled, or have ESRD), you may be eligible for Medicare benefits. If you are unsure, the most certain way to determine your eligibility is to call the Social Security Administration (SSA) at 1-800-772-1213 between the hours of 7am and 7pm (in any time zone).

However, if you are already receiving Social Security Benefits prior to your 65th birthday, then you will be enrolled into Medicare Part A and Part B automatically. The way this works is that approximately 3 months before you turn 65, you will receive you initial enrollment packet that will include your Medicare card. If you want to enroll into both A and B, sign your card and keep it in a safe place. If you want to refuse Part B, simply sign the back of the card form that you receive, put an "x" in the box that says you are refusing Part B, and send the card back using the return envelope. After the SSA receives and notes your decision, you will receive a new card listing your enrollment into Part A, only.

If you are approaching age 65 but not yet receiving Social Security Benefits, the procedure is a little different. In this case, you need to initiate the enrollment process yourself by submitting an application with Social Security. You can do this through your local office, or call the number given above for more information. In either case, whether you are already receiving SSA benefits or not, you have a 7 month initial enrollment period to sign up. This includes the 3 months before the month of your birthday, the month of your birthday, and the three months immediately following the month in which you turn 65.

To wrap up, Medicare enrollment is done through the Social Security Administration. If you are already receiving Social Security, railroad, civil service, or disability benefits, your enrollment will occur automatically. If not, and you are within 3 months of your 65 birthday, contact the SSA in order to submit an application to begin receiving your benefits.

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