Medicare

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Page last updated: 05/26/04

Medicare is the national health insurance program to which all Social Security recipients who are either over 65 years of age or permanently disabled are entitled. The current version of Medicare can be found as 42 U.S.C. 1395 et seq. Federal regulations covering Medicare can be downloaded at Title 42 C.F.R.

Medicare is not a need-based program, and should not be confused with Medicaid. The income and assets of a Medicare beneficiary are not a consideration in determining eligibility or benefit payment. Medicare is a national program and procedures should not vary significantly from state to state

Coverage under Medicare is similar to that provided by private insurance companies: i.e., it pays a portion of the cost of medical care. Often, deductibles and co-insurance (partial payment of initial and subsequent costs) are required of the beneficiary.

Medicare has two substantive coverage components, Part A and Part B:

Part A covers inpatient hospital care, hospice care, inpatient care in a skilled nursing facility, and home health care services.

Part B covers medical care and services provided by doctors and other medical practitioners, home health care, durable medical equipment, and some outpatient care and home health services.

Part A of the program is financed largely through federal payroll taxes paid into Social Security by employers and employees.

Part B is financed by monthly premiums paid by Medicare beneficiaries and by general revenues from the federal government.

In addition, Medicare beneficiaries themselves share the cost of the program through co-payments and deductibles that are required.