Medicare

Medicare Program

Agency: Department of Health and Human Services (HHS)
Office: Center for Medicare and Medicaid Services (CMS),
7500 Security Boulevard, Baltimore, Maryland 21244 Phone: (410) 786-3870

U.S. Medicare is funded by 2 trust funds, both held by the Department of the Treasury:

  1. Medicare Hospital Insurance (HI) Trust Fund – $205.4 billion as of 12/31/2013  funded from: payroll taxes, interest earned from HI Trust Fund and paid premiums for Medicare Part A used for: Medicare Part A benefits of the aged and disabled – hospital, nursing facility, home health and hospice care
  2. Medicare Supplementary Medical Insurance (SMI) Trust Fund – Part B had 74.1 billion and Part D had 1.0 billion as of 12/31/2013 funded from: general revenue transfers, insurance premiums, interest earned, and contributions from States used for: Medicare Part B benefits – doctor services and outpatient hospital care, lab tests and medical equipment Medicare Part D prescription coverage – optional benefits for prescription drugs to all with Medicare

Medicare is a U.S. Federal health insurance program administered by Department of Health and Human Services. This federal program helps Americans by providing health insurance coverage to:

1) elderly who are 65 or older,
2) people with disabilities, and
3) people with permanent kidney failure requiring dialysis or a kidney transplant.

According to the U.S. Government in 2012 Medicare health insurance program covered 50.7 million people in the United States: 42.1 million aged 65 and older, and 8.5 million disabled. The total Medicare expenditure for that year was $574.2 billion. That was more than the total income (see fund sources above) of $536.9 billion that went into the HI and SMI Trust Funds. As a result the total assets held in both Medicare trust funds decreased by $37.3 billion to $287.6 billion.

The Medicare government program offers health related help to all Americans 65 or older and people with disabilities by providing:

Hospital Insurance  – otherwise known as Medicare Part A, helps pay for hospital, home health following hospital stays, skilled nursing facility, and hospice care for the aged and disabled.

Medical Insurance – known as Medicare Part B, helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who have voluntarily enrolled.

Medicare Advantage Plans – or Medicare Part C, it serves as an alternative to traditional Part A and Part B coverage, and it is an optional medical insurance that can be purchased from private insurers. Under this option, beneficiaries can choose to enroll in and receive care from private “Medicare Advantage” health insurance plans. Medicare Part C beneficiaries will generally have access to health care and services offered by Medicare Advantage providers that are in addition to services covered by Medicare Part A and Part B.

Prescription Drug Coverage – Medicare Part D adds prescription drug coverage to your Medicare Part A and Part B. Part D of Medicare is offered by private insurance companies approved by the Medicare Program. Part D provides subsidized access to drug insurance coverage on a voluntary basis for all beneficiaries and premium and cost-sharing subsidies for low-income enrollees. Some Medicare Advantage Plans (known as Medicare Part C) may also offer prescription drug coverage under the rules of Part D.

Beneficiary Eligibility

Medicare is a national health insurance program that guarantees access to health insurance coverage to all eligible beneficiaries.

Medicare general eligibility requirements

  1. Citizenship: US Citizen, or Legal resident of the US for at least 5 years
  2. Age / Disability: 65 years or older, or under 65 years old but disabled, or have permanent kidney failure requiring dialysis or kidney transplant

In addition to the above requirements a Medicare beneficiary do not have to pay Part A premiums (Hospital Insurance) if any of the following:
You or your spouse worked at least 10 years or more in Medicare covered employment (i.e. paid FICA taxes) as a part of your payroll
or
You are on dialysis with end stage renal disease or need a kidney transplant
or
You are under 65 years old and disabled, and have been getting Social Security Disability Insurance (SSDI) benefits or Railroad Retirement Board Disability benefits for at least 2  years

How to Apply

If you want to apply for Medicare please call 1-800-772-1213 (TTY users call: 1-800-325-0778) or visit your local Social Security Office.

Check your eligibility with Medicare Eligibility Tool provided by Medicare & Medicaid Services.