Medicare

Medicare is a federal health insurance program established in 1965 and covers individuals aged 65 and older, some disabled individuals under the age of 65, and patients with end-stage renal (kidney) disease.

Medicare coverage is tied to eligibility for Social Security or Railroad Retirement benefits. In 2015, there were almost 56 million people enrolled nationwide.

The program includes:

Hospital Insurance - Also known as "Part A," Medicare hospital insurance helps cover inpatient care in hospitals, including critical access hospitals, and skilled-nursing facilities, but not custodial or long-term care. It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medical Insurance - Also known as "Part B", most people pay a monthly premium for Medicare medical insurance. It helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care.

Medicare Advantage - Also known as "Part C", Medicare Advantage plans are Medicare-approved private health insurance plans for individuals enrolled in Medicare Part A and Part B. They provide all of your Part A (hospital insurance) and 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. Each plan can vary in cost and coverage.

Prescription Drug Coverage - Also known as "Part D," most people pay a monthly premium for Medicare prescription drug coverage. Under Part D, beneficiaries choose among plans run by insurance or other private companies approved by Medicare. Each plan can vary in cost and drugs covered.

Related Resources

Special Bulletin
Member
The Centers for Medicare & Medicaid Services (CMS) July 10 issued a proposed rule that would establish a new alternative payment model (APM) fo
Special Bulletin
Member
The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) July 10 announced five new CMMI payment
Letter/Comment
Public
AHA comments on the LTCH provisions in the Centers for Medicare…
Letter/Comment
Public
AHA's comment on the Centers for Medicare & Medicaid Services’ fiscal year 2020 proposed rule on the SNF prospective payment system.
Letter/Comment
Public
AHA comments on the Centers for Medicare & Medicaid Services’ fiscal year 2020 proposed rule for the IRF prospective payment system.
Letter/Comment
Public
AHA comments on Medicare for All to House Ways and Means Committee.