Medicare ( Older Adults )
People who are younger than age 65 are eligible for Medicare if they have been entitled to Social Security disability benefits for 24 consecutive months; or railroad retirement benefits, based on disability, for 29 consecutive months; or they are insured under Social Security or railroad retirement system and need dialysis treatment or a kidney transplant. Spouses or children of insured people may also be eligible if they need maintenance dialysis or a kidney transplant.
There are three parts to the Medicare program: Hospital insurance (Part A) helps pay for inpatient hospital care, some inpatient care in a skilled nursing facility, home health care, and hospice care. Medical Insurance (Part B) helps pay for doctors' services, outpatient hospital services, durable medical equipment, and a number of other medical services and supplies that are not covered by Part A. Part D covers prescription drugs. Coverage is available through private insurance plans. There is assistance for people with limited resources and income to pay for Part D coverage. Call Social Security to find out if you are eligible for this assistance.
NEW MEDICARE CARDS In April 2018, Medicare started mailing new cards to everyone who receives Medicare benefits. New cards will no longer use social security numbers; each card will have a unique Medicare ID. Individuals are not required to do anything and there is no charge for new cards. Coverage and benefits will remain the same. QUALIFIED MEDICARE BENEFICIARY PROGRAM The Qualified Medicare Beneficiary (Q.M.B.) Program is a federal program which pays Medicare Part A hospital premiums, co-insurance, and deductibles for income-eligible Medicare recipients. The general eligibility requirements include the following:
Must be eligible for Medicare Part A (hospital insurance)
Monthly income equal to or less than $581 for a person who is unmarried or who he is not living with a spouse, or $786 for a married person living with a spouse
If an SSI/SSP recipient, the monthly grant must be $153 or more
Value of property owned may not exceed $4,000 for a single person or $6,000 for a married person living with his or her spouse (the applicant's home and one car used for transportation are not counted)
MediCal benefits received after age 65 are recoverable by the state after the person's death if the person does not leave a surviving spouse, minor children, or totally disabled child. APPLICATION PROCEDURE To enroll in Medicare, Part A and B, people walk in to any SSA office or visit www.socialsecurity.gov. People can file for Medicare online even if they are not ready to retire. People may also call the teleservice center to make an appointment. To enroll in Part D, people need to contact the prescription drug plans directly or call 1(800) Medicare.
Applicants may need to present the following documents when they file a claim:
Social Security card (or a record of their social security number)
marriage certificate (if signing up on a spouse's record)
if applying as a person with a disability, medical documentation and names, addresses, and phone numbers of doctor(s), hospitals, etc., that have provided treatment
To apply for the Q.M.B. program, people who receive, or are eligible for, SSI go to their local SSA office during the open enrollment period. People who are not SSI eligible, but meet Q.M.B. criteria, must apply for Medicare with Social Security and then apply for Q.M.B. at their local Medi-Cal office during the open enrollment period; (for Medi-Cal office locations see the entry L A County DPSS Benefits).
The open enrollment period for Q.M.B. usually runs from January 1 through March 31 each year -- but may be extended through April 30 -- for benefits to begin the following calendar year. Applications are accepted at any time, but due to the lengthy processing time (up to six months), only those accepted between January and April are likely to be completed in time for benefits to begin in the following year. There are also other enrollment periods for people reaching age 65, and for people who are legal aliens who have been U.S. residents for five consecutive years. FEES/PAYMENT SOURCE There are no fees for service.
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