Medicare

The Medicare program was created in 1965 to provide health coverage for Americans aged 65 and older. Some additional groups are also eligible for Medicare, including people on dialysis for permanent kidney failure, people with ALS (Lou Gehrig’s disease), and people who are disabled and who are receiving Social Security benefits or Railroad Retirement Board disability benefits.

Original Medicare has two parts: Part A provides hospital coverage, and Part B provides outpatient medical coverage. In 2007, Part C was added, giving beneficiaries the option to receive coverage through private “Medicare Advantage” plans. And in January 2006, Part D was added, which allows Medicare beneficiaries to enroll in one of several prescription drug plans.

Medicare coverage includes premiums, deductibles, and copayments that individuals must pay out of pocket. Medicare beneficiaries whose low incomes qualify them for Medicaid (“dual eligibles”) receive help with these out-of-pocket costs.

This section of our Web site provides information on various aspects of the Medicare program, including low-income issues, Part D prescription drug coverage, and Medicare Advantage plans.

The Latest

From Families USA:

Help for People with Medicare discusses how the health reform legislation that is before Congress will help make Medicare more affordable for seniors and people with disabilities, as well as help make the program more financially secure. (August 2009)

Setting the Record Straight on Medicare dispels several myths about health reform and explains how health reform will help Medicare beneficiaries and strengthen the program. (August 2009) l Large Print

10 Reasons to Support the Health Care Reform Bills provides a quick rundown of the most exciting provisions in the health reform bills pending in Congress, including provisions that will help middle-class and low-income families, small businesses, and seniors and people with disabilities. (July 2009)

From the Commonwealth Fund:

Paying Medicare Advantage Plans by Competitive Bidding: How Much Competition Is There? details how private insurance companies that sell Medicare Advantage (MA) plans receive 13 percent more than traditional Medicare and examines reform proposals that recommend replacing overpayments with a system of competitive bidding. Often, a small number of insurance companies dominate the MA market, meaning that a system of competitive bidding could still be highly influenced by the bids of a few companies, limiting true competition. (August 2009)

From Health Affairs:

Medicare Governance and Provider Payment Policy examines the decision-making processes governing Medicare and how they tend to become overly politicized by both Congress and the White House. The report makes several recommendations for protecting Medicare payment decisions from political interference, including establishing a new, independent Medicare policy board. (September 2009)

How Medicare Could Get Better Prices on Prescription Drugs examines federal spending for Medicare Part D plans under the current “noninterference” provision that prevents the government from negotiating prescription drug prices on behalf of enrollees. The report compares and assesses several options for reforming this system, including adopting a system of rebates similar to those used by state Medicaid programs, expanding the use of generic drugs, and other options that may reduce federal spending without requiring price negotiations. (July 2009) Subscription Required

From the Journal of Women, Politics and Policy:

Health Coverage and Expenses: Impact on Older Women’s Economic Well-Being explores gender-based differences in health and long-term care use, spending patterns, and the financial burden of out-of-pocket expenses among Medicare beneficiaries. The study reveals that women’s health care expenses were higher than men’s, and older women had an even greater overall financial burden with less income at their disposal. It concludes that controlling health spending and developing options to help finance long-term care for Medicare enrollees are key to improving the economic security of older women. (August 2009)

From the Kaiser Family Foundation:

Strategies for Simplifying the Medicare Advantage Market argues that fewer plan offerings, or more transparent differences across plans, would help beneficiaries choose the plans that are most likely to meet their individual needs. Research shows that individuals faced with a large number of alternatives often avoid making a decision, or they choose options that may not be best for them economically. This report outlines nine ways to simplify the process of choosing a plan. (July 2009)

From the New England Journal of Medicine

Medicare Part D Update—Lessons Learned and Unfinished Business examines the effects of Part D on drug coverage, access to medications, out-of-pocket spending, and overall Medicare spending. More seniors are now covered by a Medicare drug plan and report greater savings, but gaps in coverage and other problems still persist. Seniors now have dozens of Medicare drug plans to chose from, but they do not always pick the cheapest plan. (July 2009)

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