It’s almost impossible to imagine a time when Medicare didn’t exist, but prior to 1966 the concept of a federal insurance program was unthinkable. A half decade later, more than 55 million U.S. citizens are enrolled in the $172 billion program and receiving the care needed to live healthy lives.

The Centers for Medicare & Medicaid Services (CMS) has expanded its coverage over time to include more than just people age 65+. Now services are provided to young people with disabilities who qualify based on care needs and people with End-Stage Renal Disease (ESRD) — also known as kidney failure — a chronic condition that is a growing to epidemic proportions across the nation.

atom Alliance is contracted with CMS to work with healthcare providers, industry leaders, caregivers and patients to improve the quality of care issued as part of Medicare’s coverage. As one of 14 Quality Innovation Network-Quality Improvement Organizations (QIN-QIO), atom is working to target health conditions for improvement and educate consumers about the kinds of care provided through Medicare.

Medicare consists of four basic coverage options. Medicare Part A covers inpatient hospital stays, care in skilled nursing facilities, hospice care and home health. Medicare Part B covers certain doctors’ services, outpatient care, medical supplies and preventive services.

Medicare Parts C and D are plans that involve private insurance companies’ offering medical and prescription coverage. Medicare Part C — known as Medicare Advantage Plans (MAPs) — is offered by a private company that contracts with Medicare to provide all Parts A and B benefits.

MAPs usually include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) Plans, Special Needs Plans (SNPs) and Medicare Savings Account (MSA) Plans.

Medicare Part D enhances the Original Medicare plan by including prescription drug coverage. Part D can also be added to some Medicare cost, PFFS and MSA plans. All of these plans are offered though insurance companies and other private companies approved by Medicare. MAPs may also offer prescription drug coverage that follows the same rules as Medicare prescription drug plans.

Understanding the complexity of how Medicare works and combines with other options can be difficult, but not impossible. We recommend that you visit the Medicare Web site for more details on Medicare coverage choices.

And explore atomAlliance.org for additional information on how we improve healthcare!