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Medicare: Difference between revisions
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{{Short description|US government health insurance program}} | {{Short description|US government health insurance program}} | ||
{{distinguish|Medicaid|Centers for Medicare & Medicaid Services}} | {{distinguish|Medicaid|Centers for Medicare & Medicaid Services}} | ||
{{Use mdy dates|date=January 2019}} | {{Use mdy dates|date=January 2019}} | ||
{{Infobox government agency | {{Infobox government agency | ||
| name = Medicare | | name = Medicare | ||
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'''Medicare''' is a federal [[health insurance]] program in the United States for people age 65 or older and younger people with disabilities, including those with [[End Stage Renal Disease Program|end stage renal disease]] and [[amyotrophic lateral sclerosis]] (ALS or Lou Gehrig's disease). It was begun in 1965 under the [[Social Security Administration]] and is now administered by the [[Centers for Medicare and Medicaid Services]] (CMS). | '''Medicare''' is a federal [[health insurance]] program in the United States for people age 65 or older and younger people with disabilities, including those with [[End Stage Renal Disease Program|end stage renal disease]] and [[amyotrophic lateral sclerosis]] (ALS or Lou Gehrig's disease). It was begun in 1965 under the [[Social Security Administration]] and is now administered by the [[Centers for Medicare and Medicaid Services]] (CMS). | ||
In 2022, Medicare provided health insurance for 65.0 million individuals—more than 57 million people aged 65 and older and about 8 million younger people.<ref>[https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2023.pdf 2023 Annual Report of the Medicare Trustees]{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }} (for the year 2022), March 31, 2023</ref> According to annual Medicare Trustees reports and research by Congress' MedPAC group, Medicare covers about half of healthcare expenses of those enrolled. <ref>{{Cite web |title=Beneficiary Income and Out-of-Pocket Costs {{!}} CMS |url=https://www.cms.gov/data-research/statistics-trends-and-reports/trustees-report-trust-funds/beneficiary-income-and-out-pocket-costs?utm_source=chatgpt.com |access-date=2024-11-26 |website=www.cms.gov}}</ref> Enrollees cover most of the remaining costs by taking additional private insurance (medi-gap insurance), by enrolling in a Medicare Part D prescription drug plan, or by joining a private Medicare Part C (Medicare Advantage) plan. In 2022, spending by the Medicare Trustees topped $900 billion per the Trustees report Table II.B.1, of which $423 billion came from the U.S. Treasury and the rest primarily from the Part A Trust Fund (which is funded by payroll taxes) and premiums paid by beneficiaries. Households that retired in 2013 paid only 13 to 41 percent of the benefit dollars they are expected to receive.{{r | PF_2014-09 | Urban_2013 }} | |||
Beneficiaries typically have other healthcare-related costs, including Medicare Part A, B and D deductibles and Part B and C co-pays; the costs of long-term custodial care (which are not covered by Medicare); and the costs resulting from Medicare's lifetime and per-incident limits. <ref>{{Cite web |title=Long Term Care Coverage |url=https://www.medicare.gov/coverage/long-term-care?utm_source=chatgpt.com |access-date=2024-11-26 |website=www.medicare.gov |language=en}}</ref> | |||
== Parts == | |||
Medicare is divided into four parts: A, B, C and D. Part A covers hospital, skilled nursing, and hospice services. Part B covers outpatient services. Part D covers self-administered prescription drugs. Part C is an alternative that allows patients to choose private plans with different benefit structures that provide the same services as Parts A and B, usually with additional benefits. | Medicare is divided into four parts: A, B, C and D. Part A covers hospital, skilled nursing, and hospice services. Part B covers outpatient services. Part D covers self-administered prescription drugs. Part C is an alternative that allows patients to choose private plans with different benefit structures that provide the same services as Parts A and B, usually with additional benefits. | ||
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* '''[[#Part_C:_Medicare_Advantage_plans|Part C]]''' is an alternative often called Managed Medicare by the Trustees (and almost all of which are deemed Medicare Advantage plans), which allows patients to choose health plans with at least the same service coverage as Parts A and B (and most often more), often the benefits of Part D; Part C's key differences with Parts A and B are that Part C plans include an annual out-of-pocket expense limit in an amount between $1500 and $8000{{update inline|date=August 2024}} and do not have lifetime coverage limits.<ref name="official">{{cite web |title=About Medicare |url=https://www.medicare.gov/about-us/about-medicare.html |website=Medicare.gov|publisher=U.S. Centers for Medicare & Medicaid Services, Baltimore |access-date=October 25, 2017}}</ref> | * '''[[#Part_C:_Medicare_Advantage_plans|Part C]]''' is an alternative often called Managed Medicare by the Trustees (and almost all of which are deemed Medicare Advantage plans), which allows patients to choose health plans with at least the same service coverage as Parts A and B (and most often more), often the benefits of Part D; Part C's key differences with Parts A and B are that Part C plans include an annual out-of-pocket expense limit in an amount between $1500 and $8000{{update inline|date=August 2024}} and do not have lifetime coverage limits.<ref name="official">{{cite web |title=About Medicare |url=https://www.medicare.gov/about-us/about-medicare.html |website=Medicare.gov|publisher=U.S. Centers for Medicare & Medicaid Services, Baltimore |access-date=October 25, 2017}}</ref> | ||
* '''[[#Part_D:_Prescription_drug_plans|Part D]]''' covers self-administered prescription drugs. | * '''[[#Part_D:_Prescription_drug_plans|Part D]]''' covers self-administered prescription drugs. | ||
==History== | ==History== | ||
Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.<ref>Robinson, P. I. (1957). Medicare: Uniformed Services Program for Dependents. Social Security Bulletin, 20(7), pp. 9–16.</ref> President [[Dwight D. Eisenhower]] held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.<ref>Tibbits C. "The 1961 White House Conference on Aging: it's rationale, objectives, and procedures". J Am Geriatr Soc. 1960 May. 8:373–77</ref><ref>Mcnamara PAT, Dirksen EM, Church F, Muskie ES. The 1961 White House Conference on Aging: basic policy statements and recommendations / prepared for the Special Committee on Aging, United States Senate 87th Congress, 1st Session, Committee Print, May 15, 1961.</ref> | Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.<ref>Robinson, P. I. (1957). Medicare: Uniformed Services Program for Dependents. Social Security Bulletin, 20(7), pp. 9–16.</ref> President [[Dwight D. Eisenhower]] held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.<ref>Tibbits C. "The 1961 White House Conference on Aging: it's rationale, objectives, and procedures". J Am Geriatr Soc. 1960 May. 8:373–77</ref><ref>Mcnamara PAT, Dirksen EM, Church F, Muskie ES. The 1961 White House Conference on Aging: basic policy statements and recommendations / prepared for the Special Committee on Aging, United States Senate 87th Congress, 1st Session, Committee Print, May 15, 1961.</ref> | ||