II. Background
- U.S. nationwide health insurance program
- Populations covered (regardless of income)
- Age 65 years old and older
- Social Security Disability payment receivers for >=2 years or more
- End Stage Renal Disease
- Parts A and B (1965-66: Title 18 Health Insurance for the Aged of the Social Security Act)
- Part A: Hospital insurance
- Part B: Supplementary medical insurance
- Part C (Medicare Advantage, and prior Medicare+Choice, started 1997)
- Coordinated plans (e.g. Preferred provider organizations or PPOs) that may offer lower overall costs and greater services
- Part D (Medicare Prescription Drug, Improvement, and Modernization Act or MMA, 2003)
- Voluntary drug benefit
- Medicare Prescription Payment Plan (MPPP)
- Opt-In plan to spread medication payments out over the course of calendar year (instead of lump sum payments)
III. Resources
- Medicare Basics (CMS)
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| Definition (SOP) | Medicare - This is a nationwide health insurance program providing health insurance protection to people 65 years of age and over, people entitled to Social Security disability payments for 2 years or more, and people with end-stage renal disease, regardless of income. The program was enacted July 30, 1965, as Title XVIII, Health Insurance for the Aged of the Social Security Act, and became effective on July 1, 1966. From its inception, it has included two separate but coordinated programs: hospital insurance (Part A) and supplementary medical insurance (Part B). In 1999, additional choices were allowed for delivering Medicare Part A and Part B benefits. Medicare Advantage, previously Medicare+Choice, (Part C) is an expanded set of options for the delivery of health care under Medicare, created in the Balanced Budget Act passed by Congress in 1997. The term Medicare Advantage refers to options other than original Medicare. While all Medicare beneficiaries can receive their benefits through the original fee-for-service (FFS) program, most beneficiaries enrolled in both Part A and Part B can choose to participate in a Medicare Advantage plan instead. Organizations that seek to contract as Medicare Advantage plans must meet specific organizational, financial, and other requirements. Most Medicare Advantage plans are coordinated care plans, which include health maintenance organizations (HMOs), provider-sponsored organizations (PSOs), preferred provider organizations (PPOs), and other certified coordinated care plans and entities that meet the standards set forth in the law. The Medicare Advantage program also includes Medical savings account (MSA) plans, which provide benefits after a single high deductible is met, and private, unrestricted FFS plans, which allow beneficiaries to select certain private providers. These programs are available in only a limited number of states. For those providers who agree to accept the plan's payment terms and conditions, this option does not place the providers at risk, nor does it vary payment rates based on utilization. Only the coordinated care plans are considered managed care plans. Except for MSA plans, all Medicare Advantage plans are required to provide at least the current Medicare benefit package, excluding hospice services. Plans may offer additional covered services and are required to do so (or return excess payments) if plan costs are lower than the Medicare payments received by the plan. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed on December 8, 2003. The MMA established a voluntary drug benefit for Medicare beneficiaries and created a new Medicare Part D. People eligible for Medicare can choose to enroll in Part D beginning in January of 2006. For more information see http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf |
| Definition (MEDLINEPLUS) |
Medicare is the U.S. government's health insurance program for people age 65 or older. Some people under age 65 can qualify for Medicare, too. They include those with disabilities, permanent kidney failure, or amyotrophic lateral sclerosis. Medicare helps with the cost of health care. It does not cover all medical expenses or the cost of most long-term care. The program has four parts:
|
| Definition (NCI_NCI-GLOSS) | A U.S. federal health insurance program for people aged 65 years or older and people with certain disabilities. Medicare pays for hospital stays, medical services, and some prescription drugs but people who receive Medicare must pay part of their healthcare costs. |
| Definition (NCI) | The US federal health insurance program run by the Health Care Financing Administration for people 65 years of age or older, certain people with disabilities who have not reached this age, and individuals with permanent kidney failure with dialysis or a transplant. People over 65 years old, younger disabled people, and dialysis patients are eligible for the program regardless of their income. Participating beneficiaries pay part of healthcare costs through deductible amounts. Limited monthly premiums are required from beneficiaries for non-hospital coverage. |
| Definition (MSH) | Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976) |
| Definition (PSY) | Government health care program for the aged administered through the Social Security Administration or the US Health Care Financing Administration. Compare MEDICAID. |
| Concepts | Governmental or Regulatory Activity (T064) |
| MSH | D006278 |
| SnomedCT | 433661000124107 |
| HL7 | MM |
| LNC | LA15652-3 |
| English | Health Insurance for Aged and Disabled, Title 18, Health Insurance for Aged, Disabled, Title 18, Health Insurance for Aged, Title 18, HEALTH INSURANCE AGED DISABLED, HEALTH INSURANCE AGED DISABLED TITLE 18, HEALTH INSURANCE AGED TITLE 18, Medicare Program, medicare, MEDICARE, Medicare coverage (finding), Medicare coverage, Medicare |
| Swedish | Medicare |
| Czech | nemocenské pojištění pro staré a invalidy, oddíl 18 |
| Finnish | Medicare |
| Russian | STRAKHOVANIE ZDOROV'IA PRESTARELYKH I NETRUDOSPOSOBNYKH, ZDOROV'IA STRAKHOVANIE PRESTARELYKH I NETRUDOSPOSOBNYKH (RAZDEL 18 ZAKONA SOTSSTRAKHOVANIIA SSHA), MEDIKEIR, MEDIKER, МЕДИКЭР, МЕДИКЕР, ЗДОРОВЬЯ СТРАХОВАНИЕ ПРЕСТАРЕЛЫХ И НЕТРУДОСПОСОБНЫХ (РАЗДЕЛ 18 ЗАКОНА СОЦСТРАХОВАНИЯ США), МЕДИКЕЙР, СТРАХОВАНИЕ ЗДОРОВЬЯ ПРЕСТАРЕЛЫХ И НЕТРУДОСПОСОБНЫХ |
| Japanese | 老人および障害者の医療保険(アメリカ), 老人および障害者の医療保険第18項(アメリカ), メディケア(アメリカ) |
| French | Système public d'assurance-santé pour les personnes de plus de 65 ans ou atteintes d'un handicap aux États-Unis, Système public d'assurance-santé pour les plus de 65 ans et les handicapés aux États-Unis, Medicare (USA), Health Insurance for Aged and Disabled (Medicare), Titre 18 de l'assurance santé des personnes agées ou handicapées aux États-Unis |
| Polish | Program Medicare |
| Norwegian | Health Insurance for Aged and Disabled, Title 18, Medicare, Helseforsikringsordning for eldre og funksjonshemmede, USA |
| Croatian | Not Translated[Medicare] |
| German | Medicare |
| Italian | Medicare |
| Dutch | Medicare, Ziektekostenverzekering voor ouderen en gehandicapten, artikel 18 |
| Portuguese | Health Insurance for Aged and Disabled, Title 18, Medicare |
| Spanish | Health Insurance for Aged and Disabled, Title 18, Medicare |
