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What is Medicare?



Medicare, a federal health insurance program in the United States, is crucial for individuals aged 65 and older, those with certain disabilities, and those with end-stage renal disease. Enacted in 1965 by President Lyndon B. Johnson, it serves as a cornerstone of the social safety net.
Funding for Medicare comes from payroll taxes, general revenue, and beneficiary premiums, with administration handled by the Centers for Medicare & Medicaid Services (CMS), part of the Department of Health and Human Services.
The program comprises several parts:
  • Part A: Hospital Insurance covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Part B: Medical Insurance covers doctor visits, outpatient care, preventive services, and medical equipment, with beneficiaries paying a monthly premium, an annual deductible, and coinsurance.
  • Part C: Medicare Advantage plans, offered by private insurers, provide Parts A and B benefits and often additional services like vision and dental care, with varying out-of-pocket costs.
  • Part D: Prescription Drug Coverage, offered by private insurers, covers prescription drugs with beneficiaries paying premiums, deductibles, and coinsurance.
Medicare also includes free preventive services like screenings and flu shots, but it doesn't cover all healthcare needs, such as long-term care or most dental care.
Eligibility for Medicare is based on age, disability, or end-stage renal disease. Enrollment typically occurs during specific periods:
  • The Initial Enrollment Period (IEP) is seven months around one's 65th birthday.
  • The General Enrollment Period (GEP) is from January 1 through March 31 for those who missed their IEP.
  • The Annual Enrollment Period (AEP) runs from October 15 through December 7, allowing beneficiaries to make coverage changes for the following year.
Additionally, special enrollment periods may apply for certain life events like moving or losing employer coverage.
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