Medicare
The Medicare program was created in 1965 to provide health coverage for Americans aged 65 and older. Some additional groups are also eligible for Medicare, including people on dialysis for permanent kidney failure, people with ALS (Lou Gehrig’s disease), and people who are disabled and who are receiving Social Security benefits or Railroad Retirement Board disability benefits.
Original Medicare has two parts: Part A provides hospital coverage, and Part B provides outpatient medical coverage. In 2007, Part C was added, giving beneficiaries the option to receive coverage through private “Medicare Advantage” plans. And in January 2006, Part D was added, which allows Medicare beneficiaries to enroll in one of several prescription drug plans.
Medicare coverage includes premiums, deductibles, and copayments that individuals must pay out of pocket. Medicare beneficiaries whose low incomes qualify them for Medicaid (“dual eligibles”) receive help with these out-of-pocket costs.
This section of our Web site provides information on various aspects of the Medicare program, including low-income issues, Part D prescription drug coverage, and Medicare Advantage plans.
The Latest
From Families USA:
Designing Consumer-Friendly Beneficiary Assignment and Notification Processes for Accountable Care Organizations discusses the challenges advocates will face when developing these processes, and it recommends certain notification requirements and beneficiary protections. (January 2012)
Putting the Accountability in Accountable Care Organizations: Payment and Quality Measurements examines some of the challenges that advocates will face when working with policy makers, insurers, and providers to develop mechanisms that ensure that beneficiaries receive high-quality care at a lower cost. | Determining Shared Savings or Losses (January 2012)
From the Alliance for Health Reform:
Integrating Care for Dual Eligibles: What Do Consumers Want?
answers the following questions related to the 9 million people who are
eligible for both Medicare and Medicaid: How do the two programs
coordinate payment and care? What do consumers think about
fee-for-service and special needs plans? And what can policy makers
learn about program design from the attitudes of consumers? (December
2011)
From Avalere Health:
New Analysis Reveals Number of Medicare Part D Drugs Covered by Prescription Drug Plans Varies Widely shows that patients must select plans that cover their specific medication needs, rather than seeking only the lowest premiums. It also notes that patients with serious illnesses could see higher prescription costs in 2012. (November 2011)
From the Kaiser Family Foundation:
Medicare Advantage Plan Star Ratings and Bonus Payments in 2012 discusses the scaled bonus payments that will be added to the existing five-star rating system. To encourage improvements in health care quality, plans will be awarded a bonus if they receive a rating of three stars or higher. (November 2011)
Resources on Deficit-Reduction Plans provides a collection of pieces devoted to ongoing deficit reduction efforts and how they may affect Medicare, Medicaid, and other health care programs. (November 2011)
From the National Senior Citizens Law Center:
Improving the Qualified Medicare Benefit Program for Dual Eligibles explains the Qualified Medicare Beneficiary (QMB) program and focuses on four problem areas that prevent people from fully using their Medicare benefits. It recommends methods for improvement and proposes a comprehensive redesign of the QMB program. (November 2011)
From the Robert Wood Johnson Foundation and the Urban Institute:
Accountable Care Organizations in Medicare and the Private Sector: A Status Update provides an overview of ACOs, their origins, and the current status of Medicare and private health plans adopting this model. (November 2011)
From the Urban Institute:
Long-Term Care in an Era of Shrinking Government features panelists discussing how the country can deliver and finance long-term care for its rapidly aging population, what role providers will play as Medicare and Medicaid payments are cut, how communities can help elderly or disabled neighbors, and how to better prepare the long-term care workforce. (November 2011)
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