Annual Statistical Supplement, 2. Medicare Program Description and Legislative History. The following are brief summaries of complex subjects as of November 1, 2. They should be used only as overviews and general guides to the Medicare and Medicaid programs. The views expressed herein do not necessarily reflect the policies or legal positions of the Centers for Medicare & Medicaid Services (CMS) or the Department of Health and Human Services (HHS). These summaries do not render any legal, accounting, or other professional advice, nor are they intended to explain fully all of the provisions or exclusions of the relevant laws, regulations, and rulings of the Medicare and Medicaid programs. Original sources of authority should be researched and utilized. Overview. Title XVIII of the Social Security Act, designated . As part of the Social Security Amendments of 1. Medicare legislation established a health insurance program for aged persons to complement the retirement, survivors, and disability insurance benefits under Title II of the Social Security Act. When first implemented in 1. Medicare covered most persons aged 6. In 1. 97. 3, the following groups also became eligible for Medicare benefits: persons entitled to Social Security or Railroad Retirement disability cash benefits for at least 2. ESRD), and certain otherwise noncovered aged persons who elect to pay a premium for Medicare coverage. Beginning in July 2. Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) are allowed to waive the 2. Beginning March 3. Libby, Montana who are diagnosed with an asbestos- related condition are Medicare- eligible. Medicare eligibility could also apply to individuals in other areas who are diagnosed with a medical condition caused by exposure to a public health hazard for which a future public health emergency declaration is made under the Comprehensive Environmental Response, Compensation, and Liability Act of 1. The Four Parts of Medicare 4 Usually .Public Law 9. 6- 5. This very broad description of Medicare eligibility is expanded in the next section. Medicare originally consisted of two parts: Hospital Insurance (HI), also known as Part A, and Supplementary Medical Insurance (SMI), which in the past was also known simply as Part B. Part A helps pay for inpatient hospital, home health agency, skilled nursing facility, and hospice care. What’s Medicare and what are the 'parts' of Medicare? Understand every aspect of this government health insurance program by having Medicare parts explained. Understanding Medicare and its Various Parts Health-care costs have been a growing issue in. You are leaving AARP.org and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Possible Part C Changes The Medicare program currently subsidizes private insurance companies that offer Medicare Part. Part A is provided free of premiums to most eligible people; certain otherwise ineligible people may voluntarily pay a monthly premium for coverage. Part B helps pay for physician, outpatient hospital, home health agency, and other services. To be covered by Part B, all eligible people must pay a monthly premium (or have the premium paid on their behalf). A third part of Medicare, sometimes known as Part C, is the Medicare Advantage program, which was established as the Medicare+Choice program by the Balanced Budget Act of 1. Public Law 1. 05- 3. Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2. Public Law 1. 08- 1. The Medicare Advantage program expands beneficiaries' options for participation in private- sector health care plans. The MMA also established a fourth part of Medicare, known as Part D, to help pay for prescription drugs not otherwise covered by Part A or Part B. Part D initially provided access to prescription drug discount cards, on a voluntary basis and at limited cost to all enrollees (except those entitled to Medicaid drug coverage) and, for low- income beneficiaries, transitional limited financial assistance for purchasing prescription drugs and a subsidized enrollment fee for the discount cards. This temporary plan began in mid- 2. In 2. 00. 6 and later, Part D provides subsidized access to prescription drug insurance coverage on a voluntary basis for all beneficiaries upon payment of a premium, with premium and cost- sharing subsidies for low- income enrollees. Part D activities are handled within the SMI trust fund but in an account separate from Part B. It should thus be noted that the traditional treatment of . The purpose of the two separate accounts within the SMI trust fund is to ensure that funds from one part are not used to finance the other. Medicare Parts A and B, as described above, constitute the original fee-for-service Medicare program. No one plan covers all medications. Medicare Supplement Plans: Medigap For those who want extra coverage, a Medicare Supplement Plan, also known as a Medigap plan, may be something to consider. These plans are not an official part of the Medicare program. Let’s explore more information on the four parts of Medicare below. Medicare Part D is one of four parts that make up the Medicare program. Understanding how each Medicare part works can help you. How do I apply for Medicare Savings Programs? If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state: Do you have, or are you eligible for, Part A? Is your income for 2016 at, or. When Medicare began on July 1, 1. In 2. 01. 1, almost 4. Parts A and B of the Medicare program, and over 1. Medicare Advantage plan. Entitlement and Coverage. Part A is generally provided automatically and free of premiums to persons aged 6. Social Security or Railroad Retirement benefits, whether they have claimed these monthly cash benefits or not. Also, workers and their spouses with a sufficient period of Medicare- only coverage in federal, state, or local government employment are eligible beginning at age 6. Similarly, individuals who have been entitled to Social Security or Railroad Retirement disability benefits for at least 2. Medicare- only coverage who have been disabled for more than 2. Part A benefits. It should also be noted that, over the years, there have been certain liberalizations made to both the waiting period requirement and the limit on earnings allowed for entitlement to Medicare coverage based on disability.) Part A coverage is also provided to insured workers with ESRD (and to insured workers' spouses and children with ESRD), as well as to some otherwise ineligible aged and disabled beneficiaries who voluntarily pay a monthly premium for their coverage. In 2. 01. 0, Part A provided protection against the costs of hospital and specific other medical care to about 4. Part A benefit payments totaled $2. The following health care services are covered under Part A: Inpatient hospital care. Coverage includes costs of a semiprivate room, meals, regular nursing services, operating and recovery rooms, intensive care, inpatient prescription drugs, laboratory tests, X- rays, psychiatric hospitals, inpatient rehabilitation, and long- term care hospitalization when medically necessary, as well as all other medically necessary services and supplies provided in the hospital. An initial deductible payment is required of beneficiaries who are admitted to a hospital, plus copayments for all hospital days following day 6. Skilled nursing facility (SNF) care. Coverage is provided by Part A only if the care follows within 3. Covered services are similar to those for inpatient hospital care, and include rehabilitation services and appliances. The number of SNF days provided under Medicare is limited to 1. Part A does not cover nursing facility care if the patient does not require skilled nursing or skilled rehabilitation services. Home health agency (HHA) care (covered by Parts A and B). The Balanced Budget Act transferred from Part A to Part B those home health services furnished on or after January 1, 1. SNF stay. Part A will continue to cover the first 1. SNF stay; Part B covers any visits thereafter. Home health care under Parts A and B has no copayment and no deductible. HHA care, including care provided by a home health aide, may be furnished part time by an HHA in the residence of a homebound beneficiary, if intermittent or part- time skilled nursing and/or certain other therapy or rehabilitation care is necessary. Certain medical supplies and durable medical equipment may also be provided, although beneficiaries must pay a 2. Part B of Medicare. There must be a plan of treatment and periodic review by a physician. Full- time nursing care, food, blood, and drugs are not provided as HHA services. Hospice care. Coverage is provided for services to terminally ill persons with life expectancies of 6 months or less who elect to forgo the standard Medicare benefits for treatment of their illness and to receive only hospice care for it. Such care includes pain relief, supportive medical and social services, physical therapy, nursing services, and symptom management. However, if a hospice patient requires treatment for a condition that is not related to the terminal illness, Medicare will pay for all covered services necessary for that condition. The Medicare beneficiary pays no deductible for the hospice program but does pay small coinsurance amounts for drugs and inpatient respite care. An important Part A component is the benefit period, which starts when the beneficiary first enters a hospital and ends when there has been a break of at least 6. There is no limit to the number of benefit periods covered by Part A during a beneficiary's lifetime; however, inpatient hospital care is normally limited to 9. If a beneficiary exhausts the 9. Medicare coverage from a nonrenewable . Copayments are also required for such additional days. All citizens (and certain legal aliens) aged 6. Part A, are eligible to enroll in Part B on a voluntary basis by payment of a monthly premium. Almost all persons entitled to Part A choose to enroll in Part B. In 2. 01. 0, Part B provided protection against the costs of physician and other medical services to about 4. Part B benefits totaled $2. About Medicare Advantage (Medicare Part C) Print. This article was updated on: 0. What is Medicare Part C, or Medicare Advantage? Medicare Advantage plans are sometimes referred to as Medicare Part C. They are Medicare- approved private health insurance plans for individuals enrolled in Original Medicare, Part A and Part B. When you join a Medicare Advantage plan, you are still in the Medicare program and must continue paying your Part B premium. Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. They generally offer additional benefits, such as vision, dental, and hearing, and many include prescription drug coverage. These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan’s network to get care. Medicare Advantage plans may potentially save you money because out- of- pocket costs in these plans can be lower than with Original Medicare, Part A and Part B, in some cases. Pricing will vary by plan provider, so it’s worthwhile to compare all plans in your area. Your costs will vary by the services you use and the type of plan you purchase. Each Medicare Advantage plan can charge different out- of- pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or can use only doctors, facilities, or suppliers in the network). Plan options can include: Health Maintenance Organization (HMO)Preferred Provider Organization (PPO)Private Fee- for- Service (PFFS)Special Needs Plans (SNPs)HMO Point- of- Service (HMOPOS)Medical Savings Account (MSA)You can generally join if: You live in the service area of the plan you want to join. You have Original Medicare, Part A and Part B, coverage. You don’t have end- stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant); however, there are a few exceptions. Choose your plan carefully. Outside of when you first become eligible to enroll and other personal circumstances that may qualify you for a Special Election Period, you are only able to change plans once a year during the Annual Election Period. The Annual Election Period lasts from October 1. December 7 of each year. There is also a Medicare Advantage Disenrollment Period, which runs from January 1 through February 1. During this time, individuals enrolled in a Medicare Advantage plan can disenroll from their plan and return to Original Medicare coverage. One more thing to note is that Medicare Advantage plans, with or without prescription drug coverage, vary depending on where you live. To learn more about my Medicare background, see my photo and profile below. You can also schedule a phone call with me or request an email containing plan information that can help you. If you’d like to see the plans available in your area, try clicking the Compare Plans buttons on this page. If you’d like to speak to a licensed insurance agent now, just call us. Call Medicare. com’s licensed insurance agents at 1- 8. TTY users 7. 11; Monday through Friday, 8. AM to 8. PM ET. Find Affordable Medicare Plans in Your Area. Medicare Advantage. Medicare Supplement. Medicare Part DRelated Medicare Articles. Licensed Insurance Agent since 2. TTY users 7. 11. Mon - Fri, 8am - 8pm ET.
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