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Medicare

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Medicare

  • See Also
  1. Recovery Audit Contractor
  2. Affordable Care Act
  • Background
  1. U.S. nationwide health insurance program
  2. Populations covered (regardless of income)
    1. Age 65 years old and older
    2. Social Security Disability payment receivers for >=2 years or more
    3. End Stage Renal Disease
  3. Parts A and B (1965-66: Title 18 Health Insurance for the Aged of the Social Security Act)
    1. Part A: Hospital insurance
    2. Part B: Supplementary medical insurance
  4. Part C (Medicare Advantage, and prior Medicare+Choice, started 1997)
    1. Coordinated plans (e.g. Preferred provider organizations or PPOs) that may offer lower overall costs and greater services
  5. Part D (Medicare Prescription Drug, Improvement, and Modernization Act or MMA, 2003)
    1. Voluntary drug benefit
    2. Medicare Prescription Payment Plan (MPPP)
      1. Opt-In plan to spread medication payments out over the course of calendar year (instead of lump sum payments)
      2. Automatically re-enrolled yearly after initiating MPPP as of 2026 (opt-out once started)
  • Approach
  1. Medicare holds open enrollment yearly
    1. Patients should re-evaluate their plan options yearly during open enrollment
    2. Best plan for the patient may change over time
  2. Patients should be alert for Medicare Scams
    1. Use trusted resources during open enrollment
    2. Medicare does NOT cold-call patients asking for personal information to maintain Medicare benefits
    3. Free gifts and incentives are NOT offered by Medicare and should raise red flag of scam
  • Resources
  1. Medicare Basics (CMS)
    1. https://www.medicare.gov/basics
  2. Medicare Plan Finder
    1. https://www.medicare.gov/plan-compare
    2. Phone: 800-Medicare
  • References
  1. (2025) Presc Lett 32(10): 59