What is Medicare?

Medicare Application CMS 855 A: What is Medicare?

The Medicare Program is administered by the federal government of the United States of America. Medicare guarantees access to health insurance for Americans ages 65 and older as well as Americans disabled for longer than 2 years. In 1965, Congress created Medicare to provide health insurance to these individuals, regardless of income or medical history. In 1972, Congress expanded Medicare eligibility to include any American that has suffered permanent disability and receive Social Security Disability Insurance (SSDI) payments as well as those who have end-stage renal disease (ESRD). In 2001 the program was extended to cover any American with ALS (Lou Gehrig’s disease).

In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. Medicare serves a large population of old, sick, and low-income people. Without Medicare, many of these people would not have access to health insurance.

Medicare has four parts — A, B, C and D.

Part A – Hospital Insurance program, which covers inpatient hospital, skilled nursing facility, home health care and hospice care.

Part B – Supplementary Medical Insurance program, which covers physician, outpatient, home health, and preventive services. Medicare Parts A and B cover all “reasonable and necessary” medical services and hospital services, including lab tests, skilled nursing and some home health care and excluding vision, hearing, dental and long-term care.

Part C – Medicare Advantage, which allows Medicare Application enrollees to participate in private health plans that must cover all the Part A and B benefits as an alternative to Traditional Medicare.

Part D – Outpatient Prescription Drug Program.

Medicare today offers the choice of an open-network plan (Traditional Medicare) or a network plan (Medicare Advantage) with a standard benefit package. The overwhelming majority of people with Medicare have traditional Medicare (76 percent) and the rest have a Medicare Advantage plan (24 percent). With traditional Medicare, the federal government pays directly for health care. With Medicare Advantage, the federal government pays private health plans which can offer additional benefits to provide health coverage. Medicare enrollees generally have Parts A and B. If they elect to participate in Medicare Advantage, they also will have Part C. In addition, if they need prescription drug coverage, they might have Part D.

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