When Did Medicare Begin?
Medicare is a health-insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services.
The Original Medicare Program
Medicare has existed since 1965, when Congress passed the Social Security Amendments. The Amendments established both Part A and Part B of Medicare. Part A is hospital insurance, which helps pay for inpatient hospital stays. Part B is medical insurance, which helps pay for doctor's services, outpatient hospital care, home health care, durable medical equipment, and other medical services and supplies.
Medicare Part C and Medicare Part D
In 1997, Congress created a Medicare Advantage plan, and in 2003, it created the Medicare prescription-drug benefit, known as Medicare Part D. Medicare Part C is also known as Medicare Advantage. Part C helps people with both Medicare and Medicaid. Part D helps people with Medicare only.
Medicare rates for hospitals, doctors, and most other health-care providers are set by Medicare's Contracting Officer. The rates are set each year based on the Medicare Economic Index (MEI), which is a measure of health-care costs in local markets.
The MEI is set by the Office of the Actuary, CMS, in consultation with the Health Care Cost Institute (HCCI).
Medicare Prescription Drug Coverage (Medicare Part D)
Medicare Part D is prescription drug coverage that helps pay for medications. Part D is optional, and doesn't cover all prescription drugs. Part D is governed by a combination of federal and state laws.
However, the federal law that sets eligibility and certain other requirements, such as the requirement to cover preventive services without any cost-sharing, is the Social Security Act.
Medicare Prescription Drug Coverage (Medicare Part D) and the Affordable Care Act (ACA)
The Affordable Care Act (ACA) included a number of changes to Medicare Part D, including eliminating copayments for annual preventive-care visits, closing the “donut hole” in coverage, and ending cost-sharing for all other preventive services.
The ACA also added new protections for seniors, including promoting the early identification of health problems and fraud, and removing the gag rule that prohibited pharmacists from informing patients when it was cheaper to get their medications through Medicare Part D than out of pocket.
Medicare and the Social Security Act
The Social Security Act (the Act) is the federal law that governs the Medicare program. The Act also governs Social Security, Supplemental Security Income, and Medicaid.
The Act is very broad and very long, so it's important to focus on the sections that relate directly to Medicare. These sections are found in Parts A, B, and C of Title XVIII of the Act. Part A of Title XVIII is the "Hospital Insurance" section, which includes Subpart A, "General," and Subpart B, "Hospital Insurance."
The "Hospital Insurance" section of the Act covers Medicare Part A. The "Medical Insurance" section of Title XVIII covers Medicare Part B and Medicare Part D, which are set out in Subpart C and Subpart D, respectively.
The Act defines the term "Medicare" numerous times, and in a few different ways.
For example, the Act states that:
“the term ‘Medicare' means the program established pursuant to title XVIII of the Social Security Act.” (42 U.S.C. § 1395ww(h))
In another section, the Act states that:
the term ‘Medicare' means the hospital insurance program under part A of title XVIII of the Social Security Act
(42 U.S.C. § 1395i-2)
The "hospital insurance" program is the Medicare Part A program.
Other sections of the Act state that:
the term ‘Medicare' means the program that is established by title XVIII of the Social Security Act
(42 U.S.C. § 1395w-21(a)(1))
the term ‘Medicare' means the program that is established by title XVIII of the Act
(42 U.S.C. § 1395w-22(a)(1))
the term ‘Medicare' means the program established by title XVIII of the Act
(42 U.S.C. § 1395ww(h))
The "program established by title XVIII of the Act" is the Medicare Part A program.
The Medicare Part A program is also referred to as part of the "Social Security" program, which is defined in the Act as:
the old-age, survivors, and disability insurance program under title II of the Social Security Act (42 U.S.C. § 401 et seq.);
(42 U.S.C. § 1395x(d))
The Social Security Act is also referred to as the "Social Security Act of 1954," the "Social Security Act of 1965," or the "Social Security Act."
Medicare and Medicaid
Medicare and Medicaid are both government health-insurance programs.
Medicaid helps people who have little or no income and few assets because they are retired, disabled, or have low household income. It also helps people with low household income who are pregnant women, children, or families.
Medicaid is administered by the states, but the federal government sets the rates and certain other requirements.
Medicare helps people who have what is considered low or moderate income, or who