Medicare
Medicare
"Today, one in seven Americans receive Medicare benefits. This number grows daily as does the gap in funding. We cannot wait any longer to put politics aside and have an honest, straight-forward conversation about how we can save Medicare." Common Questions about Medicare (SOURCE : Congressional Research Service report “Medicare Primer”) What is Medicare? Medicare is a federal insurance program that pays for some health services of qualified citizens. It was established in 1965 under the Social Security Act as a federal entitlement program meant to provide health insurance to individuals 65 and older. In recent years, Medicare has been expanded to include some disabled individuals under the age of 65.
What is “Medicare Advantage?” Medicare Advantage (MA) is an alternative way for Medicare beneficiaries to receive covered benefits. Under Medicare Advantage, private health plans are paid as a per-person amount to provide all Medicare covered benefits (except hospice) to people who enroll in their plan. Some plans under Medicare Advantage, such as health maintenance providers (HMOs), may require enrollees to receive care from a restricted network of medical providers; enrollees may be required to see a primary care physician who will coordinate their care and refer them to specialists as necessary. Other types of private plans, such as private fee-for-service (PFFS) plans, may look more like original Medicare, with fewer restrictions on the providers an enrollee can see and minimal coordination of care.
Who is eligible for Medicare? Individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States.
How many people are enrolled in Medicare? How much does it cost to keep the program operational? Medicare is an entitlement program, which means the government is required to pay for covered services provided to eligible persons so long as specific criteria are met. Medicare currently serves approximately one in seven Americans and virtually all of the population aged 65 and over.
Since 1965, the Medicare program has undergone considerable change. The Medicare Prescription Drug, Improvement, and Modernization Act (also called the Medicare Modernization Act or MMA created Medicare Part D, which provides coverage of outpatient prescription drugs to Medicare beneficiaries who choose to enroll in this optional benefit. The law, which passed Congress in 2003, produced the largest overhaul of Medicare in the program's history. Part D plans must meet certain minimum requirements; however, there are significant variations among them in benefit design, including differences in premiums, drugs included on plan formularies, and cost-sharing for particular drugs. Medicare's payments to plans are determined through a competitive bidding process, and enrollee premiums are tied to plan bids. Part D also provides enhanced coverage for low-income enrolled individuals.
In addition, there were a number of laws, especially during the 1980s and 1990s, which included provisions designed to further stem the rapid increase in program spending though modifications to the way payments to providers were determined, and to postpone the bankruptcy of Medicare Part A. What is predicted to happen to Medicare in the future? In the absence of congressional action, the Medicare program will be unsustainable in the long run. The Part A trust fund has been estimated to go broke in 2024. And although the Part B trust fund is financed in large part through federal general revenues and cannot become insolvent, Medicare spending growth and other massive government spending projects will put increasing strains on Congress’s competing priorities. Information Source: Information from the Congressional Research Service report “Medicare Primer.”
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