Medicare History
Medicare History
Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). It started in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).
Medicare is divided into four parts: A, B, C and D.
In 2022, Medicare provided health insurance for 65.0 million individuals—more than 57 million people aged 65 and older and about 8 million younger people. According to annual Medicare Trustees reports and research by Congress' MedPAC group, Medicare covers about half of healthcare expenses of those enrolled. Enrollees cover most of the remaining costs by taking additional private insurance (medi-gap insurance), by enrolling in a Medicare Part D prescription drug plan, or by joining a private Medicare Part C (Medicare Advantage) plan.
Some Medicare Advantages are
Medicare Advantages
The main advantage to original Medicare is the broad provider market. Because of its long existence, a large number of providers accept Medicare payments for services. However, some of these providers do balance billing, which means that if their cost exceeds what Medicare pays, the consumer will be billed for the difference. The only other notable advantage to original Medicare is coverage for hospice and home health care. Home health care must be medically necessary and approved by a certified home health agency which makes its availability quite limited.
Some Medicare Disadvantages are
Medicare Disadvantages
There are two main disadvantages to original Medicare. The first is the lack of coverage for dental, hearing, vision and prescription drug coverage. The second is the potential for high out of pocket costs due to limits on coverage. Hospital stays, for example, are covered only for the first 60 days with substantial copays for the consumer for days 61-150. The consumer is responsible for all costs after 150 days. These two disadvantages both have the potential to cost the consumer thousands of dollars per year.
Summary
The main advantage to original Medicare is the broad provider market. Because of its long existence, a large number of providers accept Medicare payments for services. However, some of these providers do balance billing, which means that if their cost exceeds what Medicare pays, the consumer will be billed for the difference. The only other notable advantage to original Medicare is coverage for hospice and home health care. Home health care must be medically necessary and approved by a certified home health agency which makes its availability quite limited.
There are two main disadvantages to original Medicare. The first is the lack of coverage for dental, hearing, vision and prescription drug coverage. The second is the potential for high out of pocket costs due to limits on coverage. Hospital stays, for example, are covered only for the first 60 days with substantial copays for the consumer for days 61-150. The consumer is responsible for all costs after 150 days. These two disadvantages both have the potential to cost the consumer thousands of dollars per year.