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:
Key Priorities to Help Low-Income Medicare Beneficiaries discusses three actions Congress should take to improve the Medicare Savings Programs (MSPs) and the Part D Low-Income Subsidy (LIS) as part of health reform. (May 2009)
Medicare: Helping Low-Income Seniors and People with Disabilities examines the high out-of-pocket costs Medicare beneficiaries face and how health reform should improve existing programs that help them afford these costs. (May 2009)
From the Campaign for America’s Future:
Healthy Competition: How to Structure Public Health Insurance Plan Choice to Ensure Risk- Sharing, Cost Control and Quality Improvement examines the debate over the effectiveness of the public plan option in health reform. It also suggests the most effective ways to implement a successful public plan model. (April 2009)
From the Commonwealth Fund:
Health Insurance and Health Care Access before and after SSDI Entry sheds new light on the experiences of people with disabilities and raises the question of why many people who are eligible for Medicare are denied coverage when they are perhaps most in need of it. While the cost of eliminating the waiting period seems high, it represents only a small percentage increase in Medicare spending, and it could help states reduce their spending on public coverage programs. (May 2009)
The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009 concludes that payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee. If these beneficiaries were enrolled in traditional Medicare instead, more than $150 billion could be saved over 10 years, which could be used to finance improved benefits for the low-income elderly and disabled or for expanding health coverage. (May 2009)
Meeting Enrollees’ Needs: How Do Medicare and Employer Coverage Stack Up? finds that elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than those under age 65 who are covered by job-based plans. This study was designed to examine whether a public plan could potentially improve access to necessary services and reduce the burden of medical bills for individuals under age 65. (May 2009)
From the Kaiser Commission on Medicaid and the Uninsured:
Where Does the Burden Lie?: Medicaid and Medicare Spending for Dual Eligible Beneficiaries fills in gaps in information about dual eligibles by analyzing their demographic and health characteristics, as well as their patterns of service utilization and spending under both Medicare and Medicaid. These seniors are generally low-income, in poor health, and have considerable health care needs, making them one of the most costly populations to be covered by public insurance. (April 2009)
From the Kaiser Family Foundation:
Health Insurance Coverage for Older Adults: Implications of a Medicare Buy-In examines the barriers to securing affordable coverage in the current marketplace for uninsured people ages 55-65, as well as how a Medicare buy-in program could improve health coverage for this group. (May 2009)
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