WAG 25-02-05: Coverage Groups for Part A and Part B Medicare

COVERAGE GROUPS FOR PART A MEDICARE
Coverage Groups Automatic Coverage Must Apply Free Part A Pays for Part A
Age 65 or Over
(a) receives SSA benefits Yes No Yes No
(b) receives RR benefits Yes No Yes No
(c) insured government worker for Medicare No Yes Yes No
(d) not receiving SSA-insured No Yes Yes No
(e) not receiving RR-insured No Yes Yes No
(f) eligible for SSA and still working No Yes Yes No
(g) uninsured and no SSA or RR benefits No Yes No Yes*
Under Age 65 & Disabled for 25 Months
(a) receives SSA disability benefits based on disability as a worker, widow, widower, adult child Yes No Yes No
(b) disabled widow or widow receiving SSA benefits No Yes Yes No
(c) receives RR disability benefits Yes No Yes No
(d) insured government worker No Yes Yes No
Any Age with Kidney Failure and
(a) insured or receives SSA or RRA benefits No Yes Yes No
(b) dependent of worker who is insured or receives monthly benefits No Yes Yes No

* These are the only QMB individuals for whom HFS must pay the Part A premiums.

ENROLLMENT PERIODS FOR FREE PART A COVERAGE
1ST MONTH ELIGIBLE INITIAL ENROLLMENT PERIOD (7 MONTHS) MONTH OF ENROLLMENT COVERAGE BEGINS
04/95 01/95 - 07/95 01/95, 02/95, 03/95, 04/95, 05/95, 06/95, 07/95 04/01/95
04/95 01/95 - 07/95 12/95 06/01/95
04/95 01/95 - 07/95 10/95 04/01/95
ENROLLMENT PERIODS FOR PREMIUM PART A AND PART B COVERAGE
1ST MONTH ELIGIBLE INITIAL ENROLLMENT PERIOD (7 MONTHS) MONTH OF ENROLLMENT GENERAL ENROLLMENT** COVERAGE BEGINS
04/95 01/95 - 07/95 01/95, 02/95, 03/95 N/A 04/01/95
04/95 01/95 - 07/95 04/95 N/A 05/01/95
04/95 01/95 - 07/95 05/95 N/A 07/01/95
04/95 01/95 - 07/95 06/95 N/A 09/01/95
04/95 01/95 - 07/95 07/95 N/A 10/01/95
04/95 01/95 - 07/95 01/96, 02/96, 03/96 01/96 - 03/96 07/01/96

** General enrollment is January 1st through March 31st of each year.

NOTE: The receipt of SSI is not a factor in determining Part A eligibility.