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Medicare

Medicare was enacted in 1965 as one of President Lyndon B. Johnson's Great Society programs. The current version of Medicare can be found at 42 U.S.C. § 1395  et seq. The Medicare system was originally administered by the Social Security Administration , but in 1977 management was transferred to the Health Care Financing Administration (HCFA), since renamed the Centers for Medicare and Medicaid Services ).

Medicare is a federally funded system of health and hospital insurance for U.S. citizens age sixty-five or older, for younger people receiving Social Security  benefits, and for persons needing dialysis or kidney transplants for the treatment of end-stage renal disease. Typically, Medicare beneficiaries can receive medical care through physicians of their own choosing or through health maintenance organizations  and other medical plans that have contracts  with Medicare. (See Health Law )

Eligibility for Medicare does not depend on income; almost everyone who is sixty-five and older is entitled to coverage. Workers are not required to retire when they reach sixty-five to be protected by Medicare. Coverage under Medicare is restricted to reasonable and medically necessary treatment in a hospital; to skilled nursing home, meals, and regular nursing care services; to pay the costs of necessary special care; and for home health services and hospice care for terminally ill patients. For further information, a good starting point is the official site for Medicare .

Like other health care programs, Medicare is vulnerable to health care fraud and abuse. Patients and providers take advantage of federal health care payments through false claims, kickbacks , excessive billing, and more. Violators can be held criminally or civilly liable according to the False Claims Act , Anti-Kickback Statute , Physician Self-Referral Law , Social Security Act , and 42 U.S.C. § 1320 et seq. Suspected misconduct should be reported to the relevant contacts .

Federal Statutes

• 42 U.S.C. § 1395  et seq.

Federal Regulations

• Title 42 C.F.R., Chapter 4

Federal Judicial Decisions

• U.S. Supreme Court:

  • Recent Medicare Decisions

• U.S. Circuit Courts of Appeals: Recent Medicare Decisions

Federal Agencies:

• Center for Medicare and Medicaid Services

See also: 

• NYS Health Insurance Information

• Category: Public Benefits

[Last reviewed in July of 2023 by the Wex Definitions Team
]

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