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The Editors of Encyclopaedia Britannica Last Updated: Sep 8, 2024 • Article History Table of Contents
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Medicare and Medicaid, two U.S. government programs that guarantee health insurance for the elderly and the poor, respectively. They were formally enacted in 1965 as amendments (Titles XVIII and XIX, respectively) to the Social Security Act (1935) and went into effect in 1966.
The Medicare program covers most persons age 65 or older and consists of four related health insurance plans: a hospital insurance plan (called Part A); a supplementary medical insurance plan (Part B); and two privately run plans, Medicare Advantage (Part C) and prescription drug coverage (Part D).
The hospital plan is financed through Social Security payroll taxes. It helps pay the cost of inpatient hospital care, skilled nursing home care, and certain home health services. The plan meets most of the cost of hospital bills for up to 90 days for each episode of illness. An episode of illness is termed a “benefit period” and lasts from admittance to a hospital or nursing facility until the patient has been out of such facilities for 60 consecutive days. The patient must pay a one-time fee called a deductible for hospital care for the first 60 days in a benefit period and an additional daily fee called a co-payment for hospital care for the following 30 days; Medicare covers the rest of the expenses.
The hospital plan also pays for skilled care in a nursing facility for 100 days if such care follows a period of hospitalization within 30 days. This nursing care is free for the first 20 days after hospitalization, with the patient required to make a co-payment for any of the next 80 days. A person is thus eligible for 90 days of hospitalization and 100 days of nursing care in any benefit period. In addition, home health visits by nurses or medical technicians are covered by Medicare, as is hospice care for the terminally ill.
A patient becomes eligible for Medicare benefits again anytime he has gone for 60 consecutive days without receiving skilled care in a hospital or nursing facility; his reentry into such a facility marks the start of a new benefit period. In addition, each person has a “lifetime reserve” of 60 more hospital days that can be used at any time (including times when the 90 days covered in a benefit period have been exhausted), though a sizable co-payment is required.
Medicare’s supplementary medical insurance plan (Part B) augments the benefits provided by the hospital plan and is available to most persons 65 years or older. Persons who enroll in the plan pay a small deductible for any medical costs incurred above that amount and then pay a regular monthly premium. If these requirements are met, Medicare pays 80 percent of any bills incurred for physicians’ and surgeons’ services, diagnostic and laboratory tests, and other services. Almost all people entitled to the hospital plan also enroll in the supplementary medical plan. The latter is financed by general tax revenues and members’ payments.
