What is medicare?

What is Medicare?

Medicare is a government health insurance program managed by the Centers for Medicare & Medicaid Services (CMS), an agency of the Department of Health and Human Services (DHHS). The majority of people on Medicare are 65 and over. This coverage began as part of the Social Security program in 1965. Other people who qualify for Medicare health coverage are under 65 and disabled, which was added in 1973. The CMS reported as of July 2012 there were 51.8 million Medicare beneficiaries, of which 41.6 million were over the age of 65 (Medicare enrollment reports, 2014). Medicare coverage is expected to expand to 80 million people by 2030 when the youngest of the baby boomer generation reaches age 65 (Learn about, 2012).

In addition to the 65 and over population, Medicare covers people under 65 with certain disabilities; those who have been diagnosed with end-stage renal disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant; those who have been diagnosed with amyotrophic lateral sclerosis (ALS), also called “Lou Gehrig’s Disease; and people who are receiving or at least qualify for railroad retirement benefits (What is Medicare, 2011).

Types of Medicare Coverage

The most well-known types of Medicare coverage are Parts A, B, and D; however, there is also Part C (Medicare Advantage), Medigap, PACE (Programs of All-Inclusive Care for the Elderly), and Special Needs Plans (SNPs). Each aspect of Medicare has different payment and coverage options, as well as different eligibility criteria. The term “Original Medicare” refers to traditional, fee-for-service coverage where the government pays healthcare providers directly for Part A and/or Part B benefits. Part D is prescription drug coverage. Part C is Medicare Advantage (MA) and is an alternative to Original Medicare. These plans are provided by Medicare-approved private health insurance companies (Glossary, n.d.; SSA, 2013; Your Medicare coverage, n.d.).

The following subpages will provide additional detail information one each of these components of Medicare.

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