What is Medicare?

A look at Original Medicare, its private coverage options and who's eligible for them

  • January 11, 2018

What is Medicare?

Medicare’s origins and growth

Medicare is the federal health insurance program created in 1965 to provide health coverage for Americans aged 65 and older. Approximately 13 percent of the Medicare population is aged 85 or older.

The program – administered by the Centers for Medicare and Medicaid Services – was expanded in 1972 to cover people younger than 65 who have permanent disabilities, including those diagnosed with end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS). Approximately 17 percent of the Medicare population – or 8 million beneficiaries – are listed as under-65 and disabled.

59 million Americans are currently covered by Medicare, and funding for the program accounted for 15 percent of federal spending in 2016. The government’s net Medicare spending (ie, the government’s costs after subtracting enrollees’ premiums) is expected to grow from $590 billion in 2017 to an estimated $1.2 trillion in 2027, which is projected to be 17.5 percent of federal spending by that point.

Each part of Medicare is funded differently. Part A is funded primarily by payroll taxes, which end up in the Hospital Insurance Trust Fund. Part B revenue comes from general revenues and the premiums paid by Medicare beneficiaries. Part C (Medicare Advantage) is also paid for by general revenues and beneficiary premiums, while the Part D prescription drug plan is funded by general revenues, premiums and state payments.

Who is eligible for Medicare?

Generally speaking, you are eligible for Medicare if one of the following applies:

  • you are 65 years old, and have been a legal permanent US resident for at least five continuous years
  • you are under 65 and have amyothrophic lateral sclerosis (ALS) – also known as Lou Gehrig’s Disease – or end-stage renal disease (ERSD); or
  • you aren’t yet 65, but have been entitled to Social Security Disability benefits for at least 24 months.

In order to get Medicare Part A with no premium, you also need to have paid into the Medicare system. This means that you or your spouse must have worked for at least ten years prior to enrolling in Medicare. If not, you’re still eligible, but will have to pay a premium for Medicare Part A.

Find out when you will be eligible for Medicare and how to enroll.

How do Americans receive Medicare coverage?

The Medicare program is comprised of four main parts:

  • Medicare Part A – often referred to as “hospital insurance” – is devoted to inpatient care, covering the costs of inpatient hospital stays (of at least one night), skilled nursing facility stays (if they meet specific criteria), home health care and hospice care.
  • Medicare Part B – often called “medical insurance” – covers outpatient expenses, including physician and nursing fees, as well as a range of services (such as x-rays, diagnostic tests, and renal dialysis) and some equipment.
  • Medicare Advantage (Part C) – allows Medicare beneficiaries to receive Medicare-covered benefits through private health plans which may also include extra benefits such as prescription drug coverage. In exchange for the benefits, coverage may be limited to network of providers.
  • Medicare Part D – prescription drug coverage – provides substantial price breaks on prescription drugs for approximately 27 million Americans who enroll in Part D plans designed and administered by private health insurance companies.
  • Medicare supplement (Medigap) – is supplemental coverage purchased by Medicare beneficiaries to fill the holes in Original Medicare. The 10 different plans – lettered A through N – offer different combinations of money-saving benefits [note that the current plans C and F, both of which cover the Part B deductible in full, will no longer be available to new enrollees after the end of 2019; people who already have those plans at that point will be able to keep them, but new enrollees will no longer have access to a Medigap plan that covers that Part B deductible. The most comprehensive Medigap alternative at that point, for new enrollees, will be Plan G, which is the same as Plan F, except for the coverage of the Part B deductible.]