{ "id": "R40425", "type": "CRS Report", "typeId": "R", "number": "R40425", "active": true, "source": "CRSReports.Congress.gov, EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source_dir": "crsreports.congress.gov", "title": "Medicare Primer", "retrieved": "2020-09-07T12:23:00.507807", "id": "R40425_55_2020-05-21", "formats": [ { "filename": "files/2020-05-21_R40425_0ce2d3ed1dcd176a03a6b1a7391bb8c2ab4a3df9.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R40425/55", "sha1": "0ce2d3ed1dcd176a03a6b1a7391bb8c2ab4a3df9" }, { "format": "HTML", "filename": "files/2020-05-21_R40425_0ce2d3ed1dcd176a03a6b1a7391bb8c2ab4a3df9.html" } ], "date": "2020-05-21", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R40425", "type": "CRS Report" }, { "source": "EveryCRSReport.com", "id": 623090, "date": "2020-04-15", "retrieved": "2020-04-28T22:16:12.121447", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, or have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2020, the program is expected to cover approximately 63 million persons (54 million aged and 9 million disabled) at a total cost of about $836 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the annual appropriations process. Services provided under Parts A and B (also referred to as original or traditional Medicare) are generally paid directly by the government on a fee-for-service basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly capitated amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met.\nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modified provider reimbursements, provided incentives to increase the quality and efficiency of care, and enhanced certain Medicare benefits. In the 114th Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. \nProjections of future Medicare expenditures and funding indicate that the program will place increasing financial demands on the federal budget and on beneficiaries. For example, the Hospital Insurance (Part A) trust fund is projected to become insolvent in 2026. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare may be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R40425", "sha1": "985ed53b3e2031191b34177e56c853dacedac8f2", "filename": "files/20200415_R40425_985ed53b3e2031191b34177e56c853dacedac8f2.html", "images": { "/products/Getimages/?directory=R/html/R40425_files&id=/1.png": "files/20200415_R40425_images_d0e414146b001225dc2d57dddc95f8d95dba5b25.png", "/products/Getimages/?directory=R/html/R40425_files&id=/2.png": "files/20200415_R40425_images_83f5750a0b2a63be5d6ff36d3d5373c58a01df32.png", "/products/Getimages/?directory=R/html/R40425_files&id=/0.png": "files/20200415_R40425_images_a55544f7dcf43bde080faed3191e9857bfd8811e.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R40425", "sha1": "216d1fe1a453d8a2749166897d6a22f5f47142dd", "filename": "files/20200415_R40425_216d1fe1a453d8a2749166897d6a22f5f47142dd.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 603690, "date": "2019-08-13", "retrieved": "2019-08-16T22:14:27.974956", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, or have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2019, the program is expected to cover approximately 61 million persons (52 million aged and 9 million disabled) at a total cost of about $772 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the annual appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modified provider reimbursements, provided incentives to increase the quality and efficiency of care, and enhanced certain Medicare benefits. In the 114th Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. \nProjections of future Medicare expenditures and funding indicate that the program will place increasing financial demands on the federal budget and on beneficiaries. For example, the Hospital Insurance (Part A) trust fund is projected to become insolvent in 2026. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R40425", "sha1": "c76c195b5825174eb4c04f3e27f32fc34f58439f", "filename": "files/20190813_R40425_c76c195b5825174eb4c04f3e27f32fc34f58439f.html", "images": { "/products/Getimages/?directory=R/html/R40425_files&id=/1.png": "files/20190813_R40425_images_c50aee1fd078a20d8dfc5a780249f339cba3e1ac.png", "/products/Getimages/?directory=R/html/R40425_files&id=/2.png": "files/20190813_R40425_images_83f5750a0b2a63be5d6ff36d3d5373c58a01df32.png", "/products/Getimages/?directory=R/html/R40425_files&id=/0.png": "files/20190813_R40425_images_85a722f8c32ac826baa305b5eb14df0edad49866.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R40425", "sha1": "5c6d4479fa6be049e279f0b8f28059adad8102b8", "filename": "files/20190813_R40425_5c6d4479fa6be049e279f0b8f28059adad8102b8.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 598424, "date": "2019-05-20", "retrieved": "2019-05-20T22:08:23.512645", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, or have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2019, the program is expected to cover approximately 61 million persons (52 million aged and 9 million disabled) at a total cost of about $772 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the annual appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modified provider reimbursements, provided incentives to increase the quality and efficiency of care, and enhanced certain Medicare benefits. In the 114th Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. \nProjections of future Medicare expenditures and funding indicate that the program will place increasing financial demands on the federal budget and on beneficiaries. For example, the Hospital Insurance (Part A) trust fund is projected to become insolvent in 2026. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R40425", "sha1": "e155a2d12485dc6510945c474c682678d7142db2", "filename": "files/20190520_R40425_e155a2d12485dc6510945c474c682678d7142db2.html", "images": { "/products/Getimages/?directory=R/html/R40425_files&id=/1.png": "files/20190520_R40425_images_c50aee1fd078a20d8dfc5a780249f339cba3e1ac.png", "/products/Getimages/?directory=R/html/R40425_files&id=/2.png": "files/20190520_R40425_images_83f5750a0b2a63be5d6ff36d3d5373c58a01df32.png", "/products/Getimages/?directory=R/html/R40425_files&id=/0.png": "files/20190520_R40425_images_85a722f8c32ac826baa305b5eb14df0edad49866.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R40425", "sha1": "63a639424a7dabaf35106b10a08eb7f8bb742fe0", "filename": "files/20190520_R40425_63a639424a7dabaf35106b10a08eb7f8bb742fe0.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 584985, "date": "2018-07-05", "retrieved": "2018-09-12T22:42:05.495108", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, or have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2018, the program is expected to cover approximately 60 million persons (51 million aged and 9 million disabled) at a total cost of about $714 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. In the 114th Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2026. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "b0ec71047efd492ca8bb800a43cb2089f98da383", "filename": "files/20180705_R40425_b0ec71047efd492ca8bb800a43cb2089f98da383.html", "images": { "/products/Getimages/?directory=R/html/R40425_files&id=/1.png": "files/20180705_R40425_images_e37c1fa65e0590ef5f35ab6a4d32c29365411e24.png", "/products/Getimages/?directory=R/html/R40425_files&id=/2.png": "files/20180705_R40425_images_07608112113588fdd75149aef45f19d7505a93df.png", "/products/Getimages/?directory=R/html/R40425_files&id=/0.png": "files/20180705_R40425_images_75bd314777792a8eb35ecd4b398300e50ed048c8.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "cdfee60fd58175648b0afc1f7b72053336062c8a", "filename": "files/20180705_R40425_cdfee60fd58175648b0afc1f7b72053336062c8a.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 581301, "date": "2018-05-18", "retrieved": "2018-05-22T13:07:40.066987", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, or have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2018, the program is expected to cover approximately 60 million persons (51 million aged and 9 million disabled) at a total cost of about $714 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. In the 114th Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2029. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "a7ac267ea1e40640c08a6766d573e7cf1f5ab55b", "filename": "files/20180518_R40425_a7ac267ea1e40640c08a6766d573e7cf1f5ab55b.html", "images": { "/products/Getimages/?directory=R/html/R40425_files&id=/1.png": "files/20180518_R40425_images_e37c1fa65e0590ef5f35ab6a4d32c29365411e24.png", "/products/Getimages/?directory=R/html/R40425_files&id=/2.png": "files/20180518_R40425_images_eb64cfacf6ba3d7a0282dc4f627feb54876688ce.png", "/products/Getimages/?directory=R/html/R40425_files&id=/0.png": "files/20180518_R40425_images_75bd314777792a8eb35ecd4b398300e50ed048c8.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "0f7972d7d54666f8ed5178f01e162cc7e5001062", "filename": "files/20180518_R40425_0f7972d7d54666f8ed5178f01e162cc7e5001062.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 463445, "date": "2017-08-02", "retrieved": "2018-05-10T12:51:26.995768", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig\u2019s disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2017, the program will cover approximately 58 million persons (49 million aged and 9 million disabled) at a total cost of about $708 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. More recently, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2029. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "d4e472c49f215b80d957f56788670887c279b911", "filename": "files/20170802_R40425_d4e472c49f215b80d957f56788670887c279b911.html", "images": { "/products/Getimages/?directory=R/html/R40425_files&id=/1.png": "files/20170802_R40425_images_015969becb8f07555051784da41ebcc254fd1e0a.png", "/products/Getimages/?directory=R/html/R40425_files&id=/2.png": "files/20170802_R40425_images_eb64cfacf6ba3d7a0282dc4f627feb54876688ce.png", "/products/Getimages/?directory=R/html/R40425_files&id=/0.png": "files/20170802_R40425_images_b0a150b0b865a6a3628bb36127dd33edb33e23b1.png" } }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "dbe0090805c01593a53a7ba70d24142e4851b3af", "filename": "files/20170802_R40425_dbe0090805c01593a53a7ba70d24142e4851b3af.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 459770, "date": "2017-03-16", "retrieved": "2017-03-22T18:26:51.379538", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig\u2019s disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2017, the program will cover approximately 58 million persons (49 million aged and 9 million disabled) at a total cost of about $715 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with required benefits. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. More recently, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2028. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "a36dbdbeab31cd039d3bafcbc0f5dccab1054607", "filename": "files/20170316_R40425_a36dbdbeab31cd039d3bafcbc0f5dccab1054607.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "27c2f713adc6f83e5cf1348922b8300b9cb98c29", "filename": "files/20170316_R40425_27c2f713adc6f83e5cf1348922b8300b9cb98c29.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 4795, "name": "Disability Benefits" }, { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 455149, "date": "2016-08-17", "retrieved": "2016-09-09T18:39:58.758955", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig\u2019s disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2016, the program will cover approximately 57 million persons (48 million aged and 9 million disabled) at a total cost of about $701 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with at least a minimum standard benefit. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. More recently, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2028. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "35f841f78e6b0651ff41d3e2eed7f12b6b747977", "filename": "files/20160817_R40425_35f841f78e6b0651ff41d3e2eed7f12b6b747977.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "900c03e55864716d1c8b9c9ce0c1401fab12cd42", "filename": "files/20160817_R40425_900c03e55864716d1c8b9c9ce0c1401fab12cd42.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2177, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 452271, "date": "2016-03-31", "retrieved": "2016-05-24T19:26:47.595941", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig\u2019s disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2016, the program will cover approximately 57 million persons (48 million aged and 9 million disabled) at a total cost of about $701 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with at least a minimum standard benefit. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. More recently, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2030. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "e464102d1d20ebae3f485faa52131bf07b901116", "filename": "files/20160331_R40425_e464102d1d20ebae3f485faa52131bf07b901116.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "d2f8c754e86721ff58ab87f6647682d637f7203e", "filename": "files/20160331_R40425_d2f8c754e86721ff58ab87f6647682d637f7203e.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2177, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 450962, "date": "2016-03-21", "retrieved": "2016-03-24T16:50:31.573492", "title": "Medicare Primer", "summary": "Medicare is a federal program that pays for covered health care services of qualified beneficiaries. It was established in 1965 under Title XVIII of the Social Security Act to provide health insurance to individuals 65 and older, and has been expanded over the years to include permanently disabled individuals under the age of 65. Medicare, which consists of four parts (A-D), covers hospitalizations, physician services, prescription drugs, skilled nursing facility care, home health visits, and hospice care, among other services. Generally, individuals are eligible for Medicare if they or their spouse worked for at least 40 quarters in Medicare-covered employment, are 65 years old, and are a citizen or permanent resident of the United States. Individuals may also qualify for coverage if they are a younger person who cannot work because they have a medical condition that is expected to last at least one year or result in death, have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or have amyotrophic lateral sclerosis (ALS, Lou Gehrig\u2019s disease). The program is administered by the Centers for Medicare & Medicaid Services (CMS), and by private entities that contract with CMS to provide claims processing, auditing, and quality oversight services.\nIn FY2016, the program will cover approximately 57 million persons (48 million aged and 9 million disabled) at a total cost of about $678 billion. Spending under the program (except for a portion of administrative costs) is considered mandatory spending and is not subject to the appropriations process. Services provided under Parts A and B (also referred to as \u201coriginal\u201d or \u201ctraditional\u201d Medicare) are generally paid directly by the government on a \u201cfee-for-service\u201d basis, using different prospective payment systems or fee schedules. Under Parts C and D, private insurers are paid a monthly \u201ccapitated\u201d amount to provide enrollees with at least a minimum standard benefit. Medicare is required to pay for all covered services provided to eligible persons, so long as specific criteria are met. \nSince 1965, the Medicare program has undergone considerable change. For example, during the 111th Congress, the Patient Protection and Affordable Care Act (ACA; P.L. 111-148 and P.L. 111-152) made numerous changes to the Medicare program that modify provider reimbursements, provide incentives to increase the quality and efficiency of care, and enhance certain Medicare benefits. More recently, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) changed the method for calculating updates to Medicare payment rates to physicians and altered how physicians and other practitioners will be paid in the future. However, in the absence of further congressional action, the Medicare program is expected to be unsustainable in the long run. The Hospital Insurance (Part A) trust fund has been estimated to become insolvent in 2030. Additionally, although the Supplementary Medical Insurance (Parts B and D) trust fund is financed in large part through federal general revenues and cannot become insolvent, associated spending growth is expected to put increasing strains on the country\u2019s competing spending priorities. As such, Medicare is expected to be a high-priority issue in the current Congress, and Congress may consider a variety of Medicare reform options ranging from further modifications of provider payment mechanisms to redesigning the entire program.\nThis report provides a general overview of the Medicare program including descriptions of the program\u2019s history, eligibility criteria, covered services, provider payment systems, and program administration and financing. A list of commonly used acronyms, as well as information on beneficiary cost sharing, may be found in the appendixes.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40425", "sha1": "d700e5f51712e068f3e8cf3e14481c4e0ac82a52", "filename": "files/20160321_R40425_d700e5f51712e068f3e8cf3e14481c4e0ac82a52.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40425", "sha1": "a1f3d3dcf4debe43db8a168ade20f35cc28dcd95", "filename": "files/20160321_R40425_a1f3d3dcf4debe43db8a168ade20f35cc28dcd95.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2177, "name": "Medicare" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc808872/", "id": "R40425_2015Mar13", "date": "2015-03-13", "retrieved": "2016-03-19T13:57:26", "title": 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