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.
From Families USA:
Helping Low-Income People with Medicare Pay for Their Health Care explores why low-income people with Medicare struggle to pay for their health care and offers three ways to enable more Medicare beneficiaries to afford the care they need.
The Managed Fee-for-Service Option To Integrate Care for Dual Eligibles: A Guide for State Advocates examines the option to integrate care for dual eligibles that does not rely on private managed care companies. It looks at the strengths and weaknesses of the model and how advocates can engage with state and federal policy makers to ensure that beneficiaries’ interests are protected as these demonstrations move forward. (May 2013)
State Advocate To-Do List for 2013 outlines issues that advocates may want to address in 2013 in anticipation of the changing health care environment. (January 2013)
From the Alliance for Health Reform:
Medicare 101: What You Need to Know answers the following questions about the program: What is Medicare, and what is its role in the health care system? How has the program evolved over time? Who is eligible, and what benefits does it cover? How much does Medicare cost? And how is it financed? (February 2013)
From the Kaiser Commission on Medicaid and the Uninsured:
Implementation of Affordable Care Act Provisions to Improve Nursing Home Transparency, Care Quality, and Abuse Prevention describes the new requirements that were included in the Affordable Care Act for nursing homes that participate in Medicare and Medicaid. It also explains the reasons for incorporating these requirements into the law and the progress that has been made in implementing them so far. (January 2013)
From the Kaiser Family Foundation:
Medigap: Spotlight on Enrollment, Premiums, and Recent Trends provides a detailed look at the market for private Medicare supplemental insurance plans, known as Medigap plans, including national and state trends in enrollment and premiums. It finds that premiums for identical plans vary widely across the country and within states, and that more than half of enrollees are in plans that cover the entire deductible for Medicare Part A and Part B. (February 2013)
Policy Options to Sustain Medicare for the Future presents a variety of options for changes to Medicare that could result in savings. It discusses the possible implications of these options for Medicare beneficiaries and health care providers, and it estimates how much each option could potentially save. (January 2013)
Medicare Advantage 2013 Spotlight: Plan Availability and Premiums examines trends in the Medicare Advantage market, including the options available and premium levels. It finds that almost all of the plans that were available this year will be offered again in 2013, and premiums for beneficiaries who stay in their current plans will increase by 10 percent (on average). (December 2012)
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