What Is Medicare?





Mr. Mallon is a student at George Mason University and an intern at HNN.

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Medicare is a government service that helps provide health care for senior citizens and disabled U.S. citizens. Medicare is part of Social Security and does not provide total health care coverage. It is available to all U.S. citizens at age 65. Medicare coverage is broken into 2 distinct categories: Medicare Part A helps with hospital costs and Medicare Part B requires a monthly fee and is used to pay medical costs.

Medicare as we know it today came into existence in July of 1965 during the Johnson Administration. Franklin Roosevelt's administration was the first to address the subject of government assisted health care. During State of the Union speeches in 1943-1945, Roosevelt spoke about universal health care, and Americans being covered from "Cradle to Grave." Bills were introduced to Congress during the Roosevelt and Truman administrations; no bill ever got out of committee. Every Democratic administration from Roosevelt to Johnson lobbied and tried to introduce some sort of government assisted health coverage from 1935 until Medicare's passage in 1965.

A timeline of major events are listed below (timeline information quoted and complied from http://cms.hhs.gov, www.seniojrournal.com and www.pbs.org.):

  • June 1934 President Franklin Roosevelt created the Committee on Economic Security. The Committee sent a report to Congress in January 1935 without specific recommendations for a national health care policy, only the basic principles of a policy.
  • August 14 1935 President Roosevelt signed the Social Security Act into law. No type of government health insurance was included.
  • July 18 1938, the National Health Conference convened in Washington, D.C.
  • February 28, 1939 Senator Robert F. Wagner introduces "National Health Bill" S. 1620 incorporating recommendations of National Health Conference. Congress holds hearings on Wagner Bill and proposal dies in committee.
  • January 1943 President Roosevelt, in his State of the Union message, calls for social insurance "from the cradle to the grave."
  • January 11, 1943 President Roosevelt outlines in his State of the Union message an "economic Bill of rights," including "the right to adequate medical care and the opportunity to achieve and enjoy good health."
  • January 19, 1944 The Social Security Board, in its eighth annual report to Congress, specifically calls for compulsory National Health Insurance as part of the social security system.
  • In 1945, for the third time in as many years, President Roosevelt in his State of the Union message again makes reference to "the right to good medical care" but again no specific recommendations are made.
  • November 1946 President Truman sends health message to Congress. Revised Wagner-Murray-Dingell Bill S. 1606 and HR 4'730 providing for National Health Insurance immediately introduced.
  • May 3, 1946 Taft-Smith-Ball Bill S. 2143, authorizing grants to States for medical care to the poor, introduced as an alternative to administration Bill. No action taken on either Bill. Committee for the Nation's Health organized to promote Wagner-Murray-Dingell Bill.
  • May 19, 1947 President Truman, in a special health message to Congress, again requests a National Health Program. S. 1320 introduced by Senators Wagner and Murray a bill by Senator Taft's reintroduced S. 545.
  • Congress holds hearings May-July, 1947 on various health proposals. No action taken. Two decades of debate ensue, with opponents warning of the dangers of "socialized medicine."
  • April 1951 Social Security Administration annual report recommends health insurance for beneficiaries.
  • September 13, 1960 The Social Security Amendments of 1960 were enacted. The new law provided increased Federal grants to States for medical care programs for aged people getting old-age assistance if the increase was spent on vendor medical payments. In addition, a new program commonly referred to as "Kerr-Mills" of Federal grants to States for vendor medical care programs for aged people not on public assistance but unable to pay for needed medical services was provided. Old-age and survivors' insurance was amended to provide disability insurance benefits to disabled workers of all ages and to their dependents; the retirement test was liberalized, as well as were eligibility requirements.
  • January 1961 White House Conference on Aging is convened in Washington, sponsored by the Department of Health, Education, and Welfare.
  • January 10, 1961 Presidential task force on Health and Social Security for the American People recommends health insurance for the elderly under social security.
  • February 10, 1961 President Kennedy sends special message to Congress on health.
  • On May 20, 1961 President Kennedy addresses the Nation on the Medicare issue in a speech televised from Madison Square Garden.
  • February 10, 1964 President Johnson sends special message, "Health of the Nation," to Congress, advocating Medicare.
  • June 24, 1964 The Ways and Means Committee executive session decides to postpone action on Medicare.
  • July 7, 1964 Ways and Means Committee reports Social Security amendments Bill HR 11865 The Bill included a benefit increase, but no health care proposal.
  • July 1964 During the Republican National Convention, Ronald Regan in a speech supporting Senator Barry Goldwater's campaign for President says, "Will you resist the temptation to get a government handout for your community? Realize that the doctor's fight against socialized medicine is your fight. We can't socialize the doctors without socializing the patients. Recognize that government invasion of public power is eventually an assault upon your own business."
  • July 24, 1964 HR 11865 passed by the House.
  • August 6, 1964 Senate Committee on Finance begins hearings on HR 11865.
  • August 20, 1964 HR 11865 reported by the Finance Committee without the addition of a health insurance provision.
  • September 2, 1964 Medicare proposal passes Senate as an amendment to HR 11865.
  • October 2, 1964 House-Senate Conference Committee deadlocks, being unable to resolve differences, between Senate and House versions of HR 11865.
  • March 23, 1965 The Committee on Ways and Means of the House of Representatives approved a Bill to replace the Administration's proposal with an unprecedented package of health benefits and Social Security improvements know as the Mills Bill.
  • July 30, 1965 Medicare (the Mills Bill) is signed into law as part of the Social Security Amendments of 1965. Former President Harry Truman is the first person to enroll in Medicare. After the Medicare Bill was signed, President Johnson remarked, "…This bill, will increase social security benefits for all of our older Americans. It will improve wide range of health and medical services for Americans of all ages. In 1935 when the man that both of us loved so much, Franklin Delano Roosevelt, signed the Social Security Act, he said it was, and I quote him, "a cornerstone in a structure which is being built but it is by no means complete."

Nuts and Bolts of What Medicare is and How it Works

Medicare provides health care coverage for senior citizens and people with disabilities. It neither offers comprehensive health care coverage nor is the coverage free. Medicare does not cover annual physical exams, doctor prescribed medication, hearing aids, glasses or nursing home care.

Medicare coverage is divided into two parts:

Part A - Hospital Insurance
Part B - Medical Insurance

People are automatically eligible for Medicare if they meet any of the following criteria:

  • Persons 65 and older and are eligible to collect Social Security or Railroad benefits.
  • Persons 65 and older and the spouse or former spouse of someone who receives Social Security or Railroad Benefits.
  • Persons who have been receiving Social Security disability benefits for at least 24 months.
  • Persons who have End Stage Kidney disease or Lou Gerhigs disease.

People who are not eligible for Medicare may enroll if they meet all three of these requirements:

  • Persons age 65 and older
  • United States citizens, and legal residents who have resided in the United States for five years without leaving.
  • Persons who purchase both parts of the Medicare plan or Part B only.

Part A in Detail

Part A of Medicare is free of charge to those who are eligible for Medicare because they have paid into Social Security or Railroad Retirement.

Those who do not meet the coverage requirement may voluntarily enroll in Medicare for a monthly premium determined by the number of quarters that they paid into Social Security or Railroad Retirement. The monthly premium in 2002 was $175.

Part A covers inpatient hospital care for up to 90 days and an additional 60 reserve days that can be used only once in the individual's lifetime.

Part B in Detail

The Part B monthly premium is the same for all persons enrolled in Medicare. The Part B monthly premium is $54.00. The majority of Americans have the Part B premium taken directly out of the Social Security benefits each month.

Part B Medical Insurance helps pay for:

  • Physician services
  • Rehabilitation therapy services
  • Outpatient hospital services
  • Ambulance services

Although Medicare does provide health coverage for these services, it is not major medical coverage. Nor does it provide assistance with prescription medications. Those who rely on Medicare for health coverage often have to get private, supplemental insurance to cover what Medicare will not. According to information taken from the Anthem Blue Cross Blue Shield website on June 12, 2003 a supplemental Medicare plan with prescription benefits will cost $166 - $237 a month.

Sources: www.medicare.gov, www.seniorjournal.com , www.lib.memphis.edu/govpubs/healpol.htm, www.cms.hhs.gov and www.pbs.org.

 



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Praveen - 8/25/2003

Although Medicare does provide health coverage for these services, it is not major medical coverage. Nor does it provide assistance with prescription medications. Those who rely on Medicare for health coverage often have to get private, supplemental insurance to cover what Medicare will not. According to information taken from the Anthem Blue Cross Blue Shield website on June 12, 2003 a supplemental Medicare plan with prescription benefits will cost $166 - $237 a month.

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