Medicare

Overview

Medicare is a federal program that pays for covered health services for most people 65 years old and older and for most permanently disabled individuals under the age of 65. Medicare spending has been growing much faster than the general economy for a number of years, throwing its long-term sustainability into question.

H.R. 3590, the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), and H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152) make numerous statutory changes to the Medicare program. The Congressional Budget Office (CBO) estimates the provisions in PPACA as amended by the Reconciliation Act that affect the Medicare, Medicaid, Children’s Health Insurance and other federal programs will reduce direct spending by $511 billion over the FY 2010 to FY 2019 period. How does this affect states? More than 8 million Medicare beneficiaries also receive benefits from state Medicaid programs. These “dual eligibles” are low-income seniors and people with disabilities who rely on Medicaid to pay for Medicare premiums and services that Medicare doesen't cover.

Several changes in the new law will affect:

• Beneficiary premiums and out-of-pocket costs.
• Benefits provided through the Medicare drug program.
• Beneficiary copayments for certain preventive care services.
• Disabled TRICARE beneficiaries who are now eligible for a Part B special enrollment period and may be Medicaid beneficiaries. 

Legislators will need to keep informed of the changes in Medicare to properly conform state Medicaid programs to meet the needs of their dual-eligible populations.

For more information, contact NCSL Staff: Joy Johnson Wilson | Rachel Morgan (Washington, D.C.)