What Is Part of Medicare OR

What Is Part of Medicare OR

What Is Part of Medicare

The Medicare medical program is part of the U.S. social insurance system that provides financial assistance to American citizens and to immigrants in the country legally, who are over 65 years of age by.



To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person's working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.

Medicare Part A is part of Original Medicare (along with Part B), the government-sponsored health insurance program for those who qualify by age, disability, or certain health conditions. Medicare is generally available to United States citizens and permanent legal residents of at least five years in a row, who are at least 65 years old or receive disability benefits. Most of those who qualify for Medicare are automatically enrolled in the program. For more information about eligibility, see Medicare Eligibility. (Source: www.medicareconsumerguide.com)


1997: The Balanced Budget Act of 1997 brings seven big Medicare changes, including slowing spending to increase the fund's life span, introducing more managed care and private health plan choices for beneficiaries, and increasing beneficiary educational efforts. This act replaced the Medicare volume performance standard with a sustainable growth rate (SGR) provision to determine the conversion factor each year. The Act specifies the formula for establishing yearly SGR targets for physicians' services under Medicare. The use of SGR targets was intended to control the growth in aggregate Medicare expenditures for physicians' services.

2003: The Medicare Modernization Act of 2003 introduces a prescription drug discount card, permits competition among health plan options, and increases coverage for preventive care, as well as previews the permanent voluntary Part D prescription drug benefit coming in 2006. It also considers Medicare beneficiary income for the first time in setting premiums. This Act establishes the use of the average sales price (ASP) methodology for office-based payment for Part B drugs and biologicals, replacing a system that paid providers on the basis of a published reference price of the drug (average wholesale price). This Act set payments at a rate established by the ASP methodology and generally equal to the ASP plus 6%. (Source: www.ncbi.nlm.nih.gov)



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