II. Background
- U.S. nationwide health insurance program
- Populations covered (regardless of income)
- Age 65 years old and older
- Social Security Disability payment receivers for >=2 years or more
- End Stage Renal Disease
- Parts A and B (1965-66: Title 18 Health Insurance for the Aged of the Social Security Act)
- Part A: Hospital insurance
- Part B: Supplementary medical insurance
- Part C (Medicare Advantage, and prior Medicare+Choice, started 1997)
- Coordinated plans (e.g. Preferred provider organizations or PPOs) that may offer lower overall costs and greater services
- Part D (Medicare Prescription Drug, Improvement, and Modernization Act or MMA, 2003)
- Voluntary drug benefit
- Medicare Prescription Payment Plan (MPPP)
- Opt-In plan to spread medication payments out over the course of calendar year (instead of lump sum payments)
- Automatically re-enrolled yearly after initiating MPPP as of 2026 (opt-out once started)
III. Approach
- Medicare holds open enrollment yearly
- Patients should re-evaluate their plan options yearly during open enrollment
- Best plan for the patient may change over time
- Patients should be alert for Medicare Scams
- Use trusted resources during open enrollment
- Medicare does NOT cold-call patients asking for personal information to maintain Medicare benefits
- Free gifts and incentives are NOT offered by Medicare and should raise red flag of scam
IV. Resources
- Medicare Basics (CMS)
- Medicare Plan Finder
- https://www.medicare.gov/plan-compare
- Phone: 800-Medicare
V. References
- (2025) Presc Lett 32(10): 59