In light of Hurricane Matthew’s disruptions to beneficiary services, equipment and supplies, we are reissuing these reminders. When a Medicare beneficiary lives in an area that has been declared an emergency or disaster by the President, a Governor, or the Secretary of Health and Human Services, the usual Medicare rules for coverage and related concerns … Read more

The 50th anniversary of Medicare has given us an opportunity to reflect on all it has accomplished to advance the health and well-being of families throughout the country. It also reminds us what could have been better – and what could still be improved. We are thankful for the vision and fortitude of President Johnson … Read more

A.P., Washington State I have a pre-existing condition (Epilepsy) and if it wasn't for Medicare, I don't think I could afford the medications needed to control it. __________ L.F., Colorado Medicare has helped me in so many ways! It helped to pay for my pacemaker, plus doctor visits, medicine etc Us older folks that are on … Read more

While the Medicare Act covers physical, speech, and occupational therapies in various community-based and facility settings, coverage is often denied or inappropriately limited.  Most often, this is because the individual requires therapy to maintain her condition, or slow deterioration. When an individual is not going to improve, providers too often decline to provide therapy or … Read more

By T.P., PhD, a Medicare Beneficiary from Ohio I would like to express my view that it would be cheaper and more efficient for all to have drug coverage as part of Medicare itself and not as a separate plan handled by private insurance companies. In addition, if the government can negotiate drug prices for … Read more

By Max Richtman, President & CEO National Committee to Preserve Social Security and Medicare As we celebrate Medicare’s 50th anniversary, it’s important to remember that one of Medicare’s most important hallmarks is the program’s long and successful history of adapting to the changing demographic and health security needs of America’s seniors.  Ten thousand Americans turn … Read more

By D.C., California Last October I awoke early one morning with a severe pain radiating from my abdomen to my back. I had never had a pain quite like this before. I had recently moved, and my new primary care physician was not available. I had had a gastroenterology evaluation for acid reflux (negative) a … Read more

By Lisa Hall, Appeals Administrator, Center for Medicare Advocacy   After beginning to work for Medicare beneficiaries, I was amazed to realize that Medicare, which is a federal health care insurance that we are all entitled to and count on being there for us one day, spends so much time, money and energy trying to … Read more

By L.S., a Medicare Beneficiary from New York Medicare has kept my family from being homeless. My husband had three different kinds of cancer, with surgery and radiation. He had three necessary replacements – hip and both knees and he had to have back surgery. Medicare took care of all the bills. There is absolutely no … Read more

One of the most fundamental rights set out in the Constitution is the right to due process of law when government action harms an individual. “Due process” means both notice and an opportunity to be heard. In other words, individuals are entitled to be informed about a government action, as well as their right to … Read more

By C.G., California My younger sister who has now passed became very ill at the age of 12 years old with kidney disease. She eventually had both of her kidneys removed, and Medicare was there for the long haul. She also came down with a severe case of Rheumatoid Arthritis, and Lupus. My sister still … Read more

One of Medicare’s key strengths, compared with most other types of health insurance, is that its benefits are “defined.” The Medicare law, regulations and rules set out the minimum scope of benefits that the program must cover and outlines the out-of-pocket costs for which beneficiaries are responsible. For example, as long as certain requirements are met, … Read more

By Jenny Gore Dwyer, Washington State In 2005 my husband was diagnosed with ALS. ALS is also known as Lou Gehrig's disease…or "the Ice Bucket Challenge" disease…remember last August when everyone was dumping ice over their heads? That was for ALS. ALS is a horrible disease where the nerve cells that tell the muscles to … Read more

By V.W., a Medicare Beneficiary from Colorado I am a 77 year old woman. I only used Medicare back in the earlier part of this decade, in 2002 and 2005, when I had accidents that required surgery to repair broken bones. The “out of pocket” costs for those surgeries were in the $10,000+ range each. Thanks … Read more

By an Anonymous Beneficiary from Iowa   In the last year I lost both of my parents.  They were 92 and 94 years old when they passed away.  They had been married for 69 years and died within less than 10 months of each other. In the last decade of their lives, due to their … Read more

Many healthcare institutions are required to provide discharge planning for their Medicare patients as part of their “Conditions of Participation” in the Medicare program.  Under the Medicare program, discharge planning services are required for hospital inpatients, long-term care hospital and rehabilitation inpatients, skilled nursing facility residents, patients in swing-beds, and hospice patients.  Discharge planning services … Read more

By P. B., a Medicare Beneficiary from Colorado I would not have been able to have a career, care for others at work, care for my mother after my career or be able to NOT be a dependent at retirement time. All this is because of a prescription that is allowed because I have Medicare. I … Read more

Most people think Medicare is a government program. That’s only partly true. While Congress created Medicare, and continues to develop Medicare coverage and appeal rules, decisions to pay claims are actually made by private companies. The government does not make those decisions. This was one of the compromises made in order to pass Medicare in … Read more

By Marilyn Moon, Institute Fellow, American Institutes for Research (Center for Medicare Advocacy Luminary) Medicare is a successful program that is extremely popular with its beneficiaries who rank it higher than others do their private insurance plans.  And polls always show that people are willing to pay more for Medicare.  So why do politicians persist in … Read more

By Mary Ashkar, Senior Attorney, Center for Medicare Advocacy Prior to becoming eligible for Medicare, many Americans who have health insurance through employment are enrolled in some type of managed care plan. Health Maintenance Organizations (HMOs) are one of the most common types of managed care plans.  Generally, individuals enrolled in HMOs are restricted to … Read more

Medicare has helped my husband to go to the hospital, Dr. Visits, Prescriptions. It has given my husband a fighting chance to LIVE. Thank God for Medicare.    By L.W., the Spouse of a Medicare Beneficiary from Florida

Our country has a patchwork of different types of health insurance coverage, including individual insurance policies, employer-based insurance coverage plans available through the new Affordable Care Act, Medicaid, and Medicare – the country’s flagship insurance program. While some people go without health insurance altogether, others have different types of coverage over the course of their … Read more

"If it were not for Medicare I could not possibly afford the health care that I get." – R.B, A Medicare Beneficiary from New Mexico

Medicare is not just an acute care benefit.  It covers skilled maintenance nursing and therapy; in some cases it covers long-term home care. Also, importantly, Medicare covers many preventive services, which, when utilized, can help limit the need for more costly future care. Most Medicare beneficiaries know about the "Welcome to Medicare" physical, but Medicare covers … Read more

By Howard Back, a Medicare Beneficiary from California Medicare funding for hospice services is a wonderful thing. But there is a missing element in the system: there is no timely way a hospice patient can appeal failure of a hospice to provide a drug, or piece of equipment or other service that the patient’s physician … Read more

By LGBT Aging Advocacy (Connecticut) and CT TransAdvocacy Coalition A substantial number of physicians serving Medicare participants do not know the sexual orientation or gender identification of the LGBT elders they care for, although this can be a critical factor for their patients’ health and health care. This is particularly important to keep in mind as the current … Read more

When Medicare began to provide coverage for prescription drugs almost 10 years ago, under Part D, millions of people who previously had no drug coverage were able to access needed medications.  By any measure, the drug benefit has helped many people. While drug coverage was a key missing ingredient in Medicare coverage until then, the way … Read more

By Judith Stein, Executive Director, Center for Medicare Advocacy When Medicare was enacted in 1965, over half of people over 65 had no health insurance. The fact that Medicare provided affordable, basic health insurance was a huge boon for older Americans and their families. (People with disabilities were added to the program in 1972.)  However, … Read more

By Douglas Gould, President, Douglas Gould and Company Medicare has done so much good over the last 50 years, but it needs a tough watchdog to keep it effective in the years to come. Case in point would be the so called “Improvement Standard,” in which care managers and other Medicare decision-makers determined that benefits … Read more

By Gill Deford, Director of Litigation, Center for Medicare Advocacy In 1965, I had a summer job as a go’fer for the administrative head of a unit at Johns Hopkins Hospital in Baltimore.  Hopkins Hospital was and is one of the great teaching hospitals in the country, but I wasn’t particularly interested in health care.  … Read more

By A Medicare Beneficiary Having Medicare saved my life, and I will be forever grateful.  But I never thought of it before I was in the hospital, because I’d never really been sick. You have to fight for Medicare like your life depends on it.  Because, like me, your life may depend on it.  

By Matt Shepard My father worked his entire career for a private insurance company.  When he retired before he was 65, he and my Mom were able to remain in the HMO that his company had used.  The company was located in the next state over from my parents’ home state, and so was the network.  … Read more

Medicare is a wonderful program.  It provides important health insurance for millions of older and disabled people. But, contrary to common belief, Medicare does not cover long-term care in skilled nursing facilities (often referred to as nursing homes).  In fact, at best, Medicare only covers up to 100 days of skilled nursing facility care per … Read more

By Steve Gleason I was diagnosed with ALS four years ago.  Now I am unable to move my body, except for my eyes.  I communicate through technology called a Speech Generating Device (SGD).  The SGD allows me to maintain contact with the world around me – to express my thoughts, feelings and needs.  It allows … Read more

New York Times, June 1965 By David Lipschutz, Center for Medicare Advocacy Senior Policy Attorney In the run-up to the passage of a major expansion of health insurance coverage, a prominent and rising political figure urged people to oppose such expansion, and contact their members of Congress to express their opposition: "Write those letters now; … Read more

By Terry Berthelot, JD, MSW Somewhere in our history, it became unacceptable to die. Elizabeth Kubler-Ross described in her seminal work, On Death and Dying, dying patients forced to endure fruitless procedures and then left in their dark hospital rooms, alone, to face the inevitable.  Each death was treated as a failure. Then in the 1970’s, the … Read more

By Frank Miata, Medicare Beneficiary I wonder if "celebrating" is the appropriate stance to take towards 50 years of avoiding the obvious need for a single payer, national health care system. I am old enough to remember what life was like before Medicare and Medicaid. I remember people dying outside hospitals, denied care because they … Read more

At the Center for Medicare Advocacy's National Voices of Medicare Summit (March 20, 2015), three Medicare leaders presented their perspectives on Medicare's promise and challenges. All spoke to the value of Medicare for its intended beneficiaries: older and disabled people. They also noted the resources and funds Medicare spends on providers and private industries.    Current … Read more

By Harry Ting, PhD, Health Economist Medicare is the major driver of innovation in health insurance reimbursement. Early examples were establishing per case rates for hospitals in the form of DRG payments and requiring three day hospital stays for coverage of skilled nursing home care.  More recently, it adopted payment reductions for hospital acquired conditions and penalties … Read more

By Kevin Prindiville, Executive Director, Justice in Aging Of the 54 million people with Medicare, a staggering 25% have annual incomes below $14,400.  For these people living in retirement, or coping with a disability in poverty, Medicare coverage offers a lifeline, a chance to get needed health care. That precious red white and blue Medicare card means … Read more

Medicare home health coverage can mean the difference between an individual staying home or becoming a nursing home resident.  While the Medicare skilled nursing facility benefit is very limited, for beneficiaries who meet the coverage criteria, the home care benefit can be an ongoing Godsend. For people who can’t readily leave home without a major … Read more

Many people outside the Medicare and health care world don’t know that in 1989 Medicare was briefly, dramatically altered.  The “Medicare Catastrophic Coverage Act,” (MCCA) was the most significant revision to Medicare since its inception.  The law increased the amount of coverage available in all care settings, established limits to beneficiary cost-sharing, and added new benefits. … Read more

By Congresswoman Rosa DeLauro, CT-3 "Along with Medicaid, Social Security and now the Affordable Care Act, Medicare is a bedrock part of the American social insurance system. Its enactment was a turning point in our history that has helped ensure the elderly do not have to go without basic health care. Before Medicare, only half … Read more

We are continuously amazed at the courage and empathy of our clients.  The plaintiffs in Jimmo v. Sebelius, a class action lawsuit, filed by the Center for Medicare Advocacy in 2011 and settled in 2013, are remarkable examples of this. The Jimmo Settlement opens doors to Medicare coverage for people with long-term and chronic conditions throughout the country.  … Read more

When Medicare was enacted in 1965, it covered only older people – those 65-years old or more. In 1972, Congress added coverage for people with long-term disabilities, recognizing that like older people, they were often unable to obtain health insurance. To limit the cost of covering this new cohort, Congress added a 24-month waiting period before … Read more

By Former U.S. Senator Christopher J. Dodd For half a century our nation, through Medicare, has made a sacred trust, a promise to our seniors. A promise which says that after a lifetime of hard work and paying into the system, they could enjoy the dignity of a secure retirement that includes quality, accessible health … Read more

Medicare – one of our nation's most popular and successful programs – celebrates its 50th anniversary this year, having been signed into law by President Lyndon Johnson on July 30, 1965. Before the enactment of Medicare, only 50 percent of seniors had health insurance and 35 percent lived in poverty. That was a time when … Read more

By Connie Cherba, Iowa In early 2000, Edward, who was then 60 years old, applied for Social Security Disability.  Despite having suffered from bipolar disorder for nearly 40 years, Edward had earned a PhD, but was not able to hold a job.  While the Social Security Disability was economically important, becoming eligible for Medicare allowed … Read more

Medicare has not only provided access to care for people who could not get private insurance, it has also significantly reduced poverty.  As Nancy-Ann Min DeParle, former administrator of HCFA (Now CMS) stated in the preface to A Profile of Medicare in 1998: Few programs in the history of the United States have brought as … Read more

Most people know Medicare as one of the most successful social programs in our country’s history for its impact on the health of our older citizens and those with disabilities. But did you know that the Medicare program was key to integrating hospitals? The Civil Rights Act of 1964, stated that “No person in the … Read more