ABSTRACT
This chapter examines Medicare by looking at its origin and structure. It explores the problem of long-term care and how that has been addressed in the United States. The chapter examines the impact of the Affordable Care Act on Medicare and proposals to reform it. Medicare is open to those over 65 years of age, those disabled and receiving Social Security cash benefits, and those suffering from end-stage renal disease or amyotrophic lateral sclerosis. Medicare is financed through a combination of subscriber and tax payments. The hospital insurance and supplemental medical insurance programs are financed differently. Because of the substantial and growing cost-sharing provisions and coverage gaps, many Medicare recipients have looked for ways to supplement their Medicare plans. For Medicare beneficiaries who are also eligible for Medicaid, known as dual eligibles, there is state buy-in coverage. Financial considerations have been an important part of the politics and policy deliberations surrounding Medicare since the program’s inception.
