Medicare

Medicare
Name	Medicare
Type	Social health insurance program
Jurisdiction	United States
Administering agency	Centers for Medicare & Medicaid Services
Established	July 30, 1965
Founder	Lyndon B. Johnson
Legislation	Social Security Amendments of 1965
Website	medicare.gov

Medicare. It is a national health insurance program in the United States, begun in 1965 under the Social Security Administration and now administered by the Centers for Medicare & Medicaid Services. It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration, and people with end-stage renal disease and amyotrophic lateral sclerosis. The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.

History

The program was signed into law on July 30, 1965, by President Lyndon B. Johnson as amendments to the Social Security Act at a ceremony in Independence, Missouri, with former President Harry S. Truman present. Its creation was a key component of Johnson's Great Society domestic agenda and followed decades of advocacy, including proposals from the Truman administration and support from groups like the AFL–CIO. Major legislative expansions have occurred over time, including the addition of coverage for people with disabilities under the Social Security Amendments of 1972. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created an outpatient prescription drug benefit, known as Part D.

Eligibility and enrollment

Individuals are generally eligible if they are 65 or older and are citizens or permanent residents of the United States. Eligibility is also extended to younger people who have received Social Security Disability Insurance benefits for at least 24 months, or who have been diagnosed with end-stage renal disease or amyotrophic lateral sclerosis. Enrollment is typically handled through the Social Security Administration, with an initial enrollment period surrounding an individual's 65th birthday. Special enrollment periods exist for those covered under employer-sponsored group health plans, and late enrollment may result in financial penalties.

Benefits and coverage

Coverage is divided into distinct parts. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Part C, also known as Medicare Advantage, is an alternative offered by private companies approved by Medicare, which bundle Part A and Part B coverage and often include Part D. Part D adds prescription drug coverage through plans run by private insurers. Supplemental coverage, known as Medigap, is sold by private companies to cover costs like copayments and deductibles not covered by original plans.

Financing

Financing comes from a combination of sources. Part A is primarily funded by a dedicated payroll tax levied on employers, employees, and the self-employed through the Federal Insurance Contributions Act. Part B and Part D are funded by a combination of monthly premiums paid by enrollees and general revenues from the U.S. Treasury. The Medicare Board of Trustees, which includes the Secretary of the Treasury and the Secretary of Health and Human Services, issues annual reports on the program's financial status. The Hospital Insurance Trust Fund is a key component of the financing structure for inpatient services.

Administration and oversight

The program is administered by the Centers for Medicare & Medicaid Services, a federal agency within the U.S. Department of Health and Human Services. Day-to-day operations, such as claims processing and customer service, are handled by private contractors, including entities like Noridian Healthcare Solutions and Palmetto GBA. Oversight is conducted by several bodies, including the Office of Inspector General for the U.S. Department of Health and Human Services and the Government Accountability Office. Key policy recommendations are also made by the Medicare Payment Advisory Commission.

Criticism and controversies

The program has faced criticism over its long-term financial sustainability, with the Congressional Budget Office regularly projecting rising costs due to factors like an aging baby boomer population and increasing health care prices. There have been controversies over coverage gaps, such as the lack of comprehensive benefits for long-term care, dental care, and hearing aids. The complexity of the program, including the multitude of Part D plans, has been cited as a source of confusion for beneficiaries. Fraud and abuse by providers, investigated by agencies like the Federal Bureau of Investigation, have also been persistent concerns, alongside debates over reimbursement rates to hospitals and physicians.

Category:Health insurance in the United States Category:1965 establishments in the United States Category:Great Society programs