Medicare at a Glance


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O VERVIEW OF M EDICARE Medicare is the federal health insurance program covering nearly 42 million Americans—35.4 million seniors and 6.3 million people under age-65 with permanent disabilities. Most individuals 65 and older are entitled to Medicare Part A if they or their spouse are eligible for Social Security payments and have made payroll tax contributions for 10 years. People under 65 who receive Social Security Disability Insurance (SSDI) payments generally become eligible for Medicare after a two-year waiting period. Medicare benefits are expected to total $325 billion in 2005, accounting for 13% of the federal budget (CBO). C HARACTERISTICS OF P EOPLE ON M EDICARE Medicare covers a diverse population: 35% of beneficiaries have three or more chronic conditions, 29% are in fair/poor health, and 27% have cognitive impairments. A relatively small share of beneficiaries (12%) account for a large share (69%) of total spending. Many on Medicare live with modest incomes and assets; 51% have incomes below 200% of poverty ($19,140/single and $25,660/couple in 2005); and 48% of non-institutionalized Medicare beneficiaries have countable assets (savings accounts, stocks, bonds, etc.) below $10,000. M EDICARE AND P RESCRIPTION D RUGS Beginning in January 2006, beneficiaries will have access to private plans that contract with Medicare to provide the new Part D prescription drug benefit. Beneficiaries will be able to enroll in prescription drug plans (PDPs) and get all other benefits from traditional Medicare, or they can enroll in Medicare Advantage plans, such as HMOs or PPOs, for all Medicare benefits, including drug coverage. Medicare will provide additional help for beneficiaries with limited incomes and assets under the new drug benefit. HHS estimates that 14.4 million beneficiaries will be eligible for premium and cost-sharing subsidies in 2006 and that 10.9 million will receive them. T HE R OLE OF S UPPLEMENTAL C OVERAGE Medicare covered less than half (45%) of beneficiaries’ total health care services in 2002. Gaps in coverage (notably long- term care, dental, and until 2006, prescription drugs) combined with relatively high cost-sharing requirements resulted in Skilled Nursing Facilities Hospital Outpatient Other Part B Benefits Hospital Inpatient Hospice Physicians and Other Suppliers Home Health Managed Care (Part C) Total = $325 billion
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This note was uploaded on 04/28/2008 for the course CH 2 taught by Professor Mckissick during the Fall '07 term at Tufts.

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