Trying to help woman with medicare part A get more coverage, part b and d

What is Medicare? .............................................................................................................................. 1

Medicare is a federal entitlement program that provides health insurance coverage to 47 million people,
including people age 65 and older, and younger people with permanent disabilities, end-stage renal
disease, and Lou Gehrig’s disease.

Who is eligible for Medicare?..............................................................................................................2

Individuals become eligible for Medicare when they reach age 65, if they or their spouse made payroll tax
contributions for 10 or more years. People under age 65 qualify for Medicare after 24 months of receiving
Social Security Disability payments, or if they have end-stage renal disease or Lou Gehrig’s disease.

What are the characteristics of people with Medicare? ..................................................................... 3

Medicare covers a diverse population. Most people with Medicare live on modest incomes and many
have multiple chronic conditions.

What does Medicare cover and how much do beneficiaries pay for benefits?...................................5

Medicare covers basic health services, including hospital stays, physician visits, and prescription drugs.
Many benefits are subject to deductibles and cost-sharing requirements. Medicare does not cover most
long-term care services, vision or dental care, or hearing aids.

What is the Medicare prescription drug benefit? ............................................................................... 7

Medicare helps cover the cost of prescription drugs offered through private drug plans. More than half of
all beneficiaries are enrolled in a Part D drug plan, with 90 percent having some source of drug coverage.

What is Medicare Advantage? ............................................................................................................ 9

Medicare Advantage plans are private health plans that receive payments from Medicare to provide
Medicare-covered benefits to enrollees. Nearly one-fourth of all beneficiaries are enrolled in a Medicare
Advantage plan.

What types of supplemental insurance do beneficiaries have? ....................................................... 11

Most beneficiaries have some type of supplemental insurance to help pay Medicare’s cost-sharing
requirements and fill gaps in Medicare’s benefit package. Primary sources of supplemental coverage
include employer-sponsored plans, Medicaid (for those with limited incomes and assets), Medigap policies,
and Medicare Advantage plans.

How do Medicare beneficiaries fare with respect to access to care?............................................... 13

The enactment of Medicare dramatically improved access to care for millions of elderly Americans.
Beneficiaries generally enjoy broad access to physicians, hospitals, and other providers, and report
relatively low rates of problems across a number of access measures.

How is Medicare financed? ............................................................................................................... 14

Funding for Medicare comes primarily from general revenues (40 percent) and payroll taxes (38 percent),
followed by premiums paid by beneficiaries (12 percent).

How much does Medicare cost and how is the money spent? ......................................................... 15

Medicare is estimated to account for 12 percent of federal spending in 2010. Inpatient hospital services
comprise the largest share of Medicare benefit payments (27 percent), followed by payments to Medicare
Advantage plans (24 percent) and physicians and other suppliers (18 percent). The drug benefit
accounts for 11 percent of total payments.

How is the health care reform law expected to affect future Medicare spending? ......................... 17

The 2010 health care reform law includes a number of provisions that are expected to reduce the
growth in Medicare spending over the next decade and beyond, thereby maintaining the solvency of the
Medicare Part A (Hospital Insurance) Trust Fund through 2029.

What are Medicare’s future financing challenges?...........................................................................19

With rising health care costs, an aging population, and a declining ratio of workers to retirees, financing
care for future beneficiaries remains a challenge.