Medicare (United States)

Medicare

Agency overview
Formed	July 30, 1965 (1965-07-30)
Headquarters	7500 Security Boulevard, Baltimore, MD 21244
Agency executive	Chiquita Brooks-LaSure, Administrator
Parent department	Centers for Medicare and Medicaid Services
Website	www.medicare.gov

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 was begun in 1965 under the Social Security Administration (SSA) and is now administered by the Centers for Medicare and Medicaid Services (CMS).

In 2022, according to the 2023 Medicare Trustees Report, Medicare provided health insurance for 65.0 million individuals—more than 57 million people aged 65 and older and about 8 million younger people.^[1] According to annual Medicare Trustees reports and research by Congress' MedPAC group, Medicare covers about half of healthcare expenses of those enrolled. Enrollees almost always cover most of the remaining costs by taking additional private insurance and/or by joining a public Medicare Part C and/or Medicare Part D health plan. In 2022, spending by the Medicare Trustees topped $900 billion per the Trustees report Table II.B.1, of which $423 billion came from the U.S. Treasury and the rest primarily from the Part A Trust Fund (which is funded by payroll taxes) and premiums paid by beneficiaries. Households that retired in 2013 paid only 13 to 41 percent of the benefit dollars they are expected to receive.^[2][3]

No matter which of those supplemental options the beneficiaries choose—private insurance or public health plans—to make up for the shortfall of what Medicare covers (or if they choose to do nothing), beneficiaries also have other healthcare-related costs. These additional costs can include but are not limited to Medicare Part A, B and D deductibles and Part B and C co-pays; the costs of long-term custodial care (which Medicare does not consider health care); the cost of annual physical exams (for those not on Part C health plans almost all of which include physicals); and the costs related to basic Medicare's lifetime and per-incident limits.

Medicare is divided into four Parts: A, B, C and D. Part A covers hospital, skilled nursing, and hospice services. Part B covers outpatient services. Part D covers self-administered prescription drugs. Additionally, Part C is an alternative that allows patients to choose their own plans with different benefit structures and that provide the same services as Parts A and B, almost always with additional benefits. The specific details on these four Parts are as follows:

• Part A covers hospital (inpatient, formally admitted only), skilled nursing (only after being formally admitted to a hospital for three days and not for custodial care), home health care, and hospice services.
• Part B covers outpatient services including some providers' services while inpatient at a hospital, outpatient hospital charges, most provider office visits even if the office is "in a hospital", durable medical equipment, and most professionally administered prescription drugs.
• Part C is an alternative often called Managed Medicare by the Trustees (and almost all of which are deemed Medicare Advantage plans), which allows patients to choose health plans with at least the same service coverage as Parts A and B (and most often more), often the benefits of Part D; Part C's key difference with Parts A and B is that C plans always include an annual out-of-pocket expense limit in an amount between $1500 and $8000 of the beneficiary's choosing; Parts A and B lack that protection. A beneficiary must enroll in Parts A and B first before signing up for Part C.^[4]
• Part D covers mostly self-administered prescription drugs.