Types of Medicare Coverage

Medicare is a 2-part Federal health insurance program for people age 65 or older and certain disabled people. One part is Hospital insurance (also called Part A). The other part is Medical insurance (also called Part B).

Hospital insurance can help pay for:

• medically necessary inpatient hospital care;
• inpatient care in a skilled nursing facility; and
• care in your home by a home health agency.

Medical insurance can help pay for:

• medically necessary doctor’s services;
• outpatient hospital services;
• outpatient physical therapy and speech pathology services; and
• a number of other medical services and supplies that are not covered by the hospital insurance part of Medicare.

If you are "permanently disabled" for any "regular work" and receive a monthly retirement or disability annuity, early Medicare coverage may begin after a waiting period (see Waiting Period Requirement for Early Medicare Defined).

If you suffer from chronic renal disease, early Medicare coverage may begin after a 3-month waiting period. Contact the Social Security Administration for this coverage.

Eligibility Requirements for Early Medicare

General

To receive Medicare coverage before age 65, an age-and-service or disability annuitant must have a period of disability.

Special Provision for Occupational Disability Annuitants

If you receive an occupational disability annuity and could not meet the disability requirements for a period of disability when your annuity began, you may qualify for early Medicare coverage at a later date if:

• your condition becomes more severe and you meet the period of disability requirement, or
• you did not meet the period of disability earnings requirement when you met the period of disability requirement, but you met the earnings requirement on the date your annuity began.

Special Provisions for Federal Employment after December 1982

If you meet the disability requirement for a period of disability but cannot meet the earnings requirement because you did not have enough social security or railroad retirement work credits, Federal employment beginning January 1983 may be counted toward meeting the earnings requirement to establish entitlement to Medicare.

When Your Early Medicare Can Begin

A. If You Have a Period of Disability

Your Medicare coverage will begin the latest of:

• the 25th month you are entitled to retirement or disability benefits, or
• the 30th month after your disability began.

B. If You Meet the Special Provision for Occupational Disability Annuitants

Your Medicare coverage will begin the 30th month after you have met the period of disability requirement and been entitled to an occupational disability annuity.

C. If You Meet the Special Provision for Federal Employment after December 1992

Your Medicare coverage will begin the latest of:

• the 25^th month you are entitled to retirement or disability benefits, or
• the 30^th month after you have met both the period of disability requirement and the period of disability earnings requirement, using Federal employment.

Note: Months you were previously entitled to an annuity or a period of disability may be counted toward the calendar month requirements above, provided the current annuity or period of disability begins within 5 years of the month the previous annuity or period of disability ended.

When Your Early Medicare Could End

Medical Recovery

If it is determined that your condition has improved and that you are medically able to work, your Medicare coverage will end. This is true whether or not you have actually worked. When this happens, your early Medicare coverage ends with the latest of:

• the last day of the 2^nd month after the month in which medical recovery occurs, or
• the last day of the month after the month in which you were notified in writing that your disability ended.

Work

If you are working, or have worked since your coverage began, your early Medicare coverage may end. This is true even though your medical condition may not have improved. Unless medical recovery occurs first, your early Medicare coverage ends with the earlier of:

• the last day of the 24^th month after you have completed a "trial work period" and it is determined you performed "substantial gainful work", or
• the last day of the month in which death occurs.

Enrollment for Early Medicare

As soon as you are determined to be eligible for Medicare, you will automatically be enrolled for Hospital insurance coverage (Part A). You pay nothing for this coverage. You will also be automatically enrolled for Medical insurance coverage (Part B). You will have to pay a monthly premium for Part B. If you receive an annuity, the premium will usually be deducted from your monthly annuity rate. If you later choose not to receive Part B coverage, you must notify the Railroad Retirement Board.