162-452: Blue Cross Blue Shield Association , also known as BCBS , BCBSA , or The Blues , is a United States –based federation with 33 independent and locally-operated BCBSA companies that provide health insurance in the United States to more than 115 million people as of 2022. It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became
324-562: A " Special Relationship " with the United Kingdom and strong ties with Canada , Australia , New Zealand , the Philippines , Japan , South Korea , Israel , and several European Union countries ( France , Italy , Germany , Spain , and Poland ). The U.S. works closely with its NATO allies on military and national security issues, and with countries in the Americas through
486-501: A "deductible") at the beginning of the 60 days of $ 1632 as of 2024. Days 61–90 require a co-payment of $ 408 per day as of 2024. The beneficiary is also allocated "lifetime reserve days" that can be used after 90 days. These lifetime reserve days require a copayment of $ 816 per day as of 2024, and the beneficiary can use a total of only 60 of these days throughout their lifetime. A new pool of 90 hospital days, with new copays of $ 1632 in 2024 and $ 408 per day for days 61–90, starts only after
648-551: A beneficiary's covered medical costs and many costs and services are not covered at all. The program contains premiums , deductibles and coinsurance, which the covered individual must pay out-of-pocket . A study published by the Kaiser Family Foundation in 2008 found the Fee-for-Service Medicare benefit package was less generous than either the typical large employer preferred provider organization plan or
810-515: A bill providing for healthcare for the elderly, all without success. In 1963, however, a bill providing for both Medicare and an increase in Social Security benefits passed the Senate by 68-20 votes. As noted by one study, this was the first time that either chamber “had passed a bill embodying the principle of federal financial responsibility for health coverage, however limited it may have been.” There
972-845: A component of the U.S. Department of Health and Human Services (HHS), administers Medicare, Medicaid , the Children's Health Insurance Program (CHIP), the Clinical Laboratory Improvement Amendments (CLIA), and parts of the Affordable Care Act (ACA) ("Obamacare"). Along with the Departments of Labor and Treasury , the CMS also implements the insurance reform provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and most aspects of
1134-1083: A copay for outpatient drugs and respite care, if needed. The Monthly Premium for Part B for 2024 is $ 174.70 per month. Part B coverage begins once a patient meets his or her deductible ($ 240 for 2024), then typically Medicare covers 80% of the RUC-set rate for approved services, while the remaining 20% is the responsibility of the patient, either directly or indirectly by private group retiree or Medigap insurance. Part B coverage covers 100% for preventive services such as yearly mammogram screenings, osteoporosis screening, and many other preventive screenings. Part B also helps with durable medical equipment (DME), including but not limited to canes , walkers , lift chairs , wheelchairs , and mobility scooters for those with mobility impairments . Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy , as well as one pair of eyeglasses following cataract surgery , and oxygen for home use are also covered. Anyone on Social Security (SS) in 2019
1296-572: A decentralized government that operated until 1789. After the British surrender at the siege of Yorktown in 1781 American sovereignty was internationally recognized by the Treaty of Paris (1783), through which the U.S. gained territory stretching west to the Mississippi River, north to present-day Canada, and south to Spanish Florida . The Northwest Ordinance (1787) established the precedent by which
1458-407: A few prominent industrialists , largely by their formation of trusts and monopolies to prevent competition. Tycoons led the nation's expansion in the railroad , petroleum , and steel industries. The United States emerged as a pioneer of the automotive industry . These changes were accompanied by significant increases in economic inequality , slum conditions , and social unrest , creating
1620-448: A final rule concerning eligibility for hospital inpatient services effective October 1, 2013. Under the new rule, if a physician admits a Medicare beneficiary as an inpatient with an expectation that the patient will require hospital care that "crosses two midnights", Medicare Part A payment is "generally appropriate". However, if it is anticipated that the patient will require hospital care for less than two midnights, Medicare Part A payment
1782-644: A global reach. The U.S. is a founding member of the World Bank , Organization of American States , NATO , and the United Nations , as well as a permanent member of the UN Security Council . The first documented use of the phrase "United States of America" is a letter from January 2, 1776. Stephen Moylan , a Continental Army aide to General George Washington , wrote to Joseph Reed , Washington's aide-de-camp , seeking to go "with full and ample powers from
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#17331159986191944-471: A joint marketing agreement with Highmark Blue Shield in Pittsburgh for their separate hospital and medical plans. However, Independence Blue Cross, like most of its sister Blue Cross Blue Shield companies, cover most of their customers under managed care plans such as HMOs and PPOs which provide hospital and medical care in one policy. Blue Cross & Blue Shield of Rhode Island was founded in 1939. The insurer
2106-458: A long term disability that would prevent you from working, End-Stage Renal Disease, or Amyotrophic lateral sclerosis then you may be eligible for Medicare at an earlier age. Individuals receiving Social Security Disability Insurance (SSDI) benefits for 24 months are automatically enrolled in Medicare Parts A and B in the 25th month. Individuals with permanent kidney failure requiring dialysis or
2268-535: A month. A new income-based premium surtax schema has been in effect since 2007, wherein Part B premiums are higher for beneficiaries with incomes exceeding $ 85,000 for individuals or $ 170,000 for married couples. Depending on the extent to which beneficiary earnings exceed the base income, these higher Part B premiums are from 30% to 70% higher with the highest premium paid by individuals earning more than $ 214,000, or married couples earning more than $ 428,000. This extra amount
2430-554: A monthly premium in addition to the Medicare Part B premium to cover items not covered by Original Medicare (Parts A & B), such as the OOP limit, self-administered prescription drugs, dental care, vision care, annual physicals, coverage outside the United States, and even gym or health club memberships as well as—and probably most importantly—reduce the 20% co-pays and high deductibles associated with Original Medicare. But in some situations
2592-458: A mutual insurance company, with the name again changed, to Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company. During 2022, BCBS and University of Mississippi Medical Center (UMMC) network entered conflict over who is to blame for an increasing lack of covered care in the state. Media reported that UMMC had paid close to $ 279,000 for digital advertising, commercials, and billboards to attack BCBS, which, in subsequent months, sued
2754-1002: A partnership with Cambia Health , but cancelled the agreement later that year. Dr. Patrick H. Conway , who had served as CEO from 2017, was scheduled to become CEO of the merged company, replacing retiring Cambia CEO Mark Ganz, but resigned after a DWI arrest in June 2019, putting the merger on hold. Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage, today that split only exists for traditional health insurance plans in Pennsylvania . Two independent companies operate in central Pennsylvania, Highmark Blue Shield in Pittsburgh and Capital Blue Cross in Central Pennsylvania. In southeastern Pennsylvania, Independence Blue Cross in Philadelphia has
2916-410: A patient, regardless of the actual amount of care. The actual allotment of funds is based on a list of diagnosis-related groups (DRG). The actual amount depends on the primary diagnosis that is actually made at the hospital. There are some issues surrounding Medicare's use of DRGs because if the patient uses less care, the hospital gets to keep the remainder. This, in theory, should balance the costs for
3078-583: A period of heightened, overt racism following Reconstruction, a time often called the nadir of American race relations . A series of Supreme Court decisions, including Plessy v. Ferguson , emptied the Fourteenth and Fifteenth Amendments of their force, allowing Jim Crow laws in the South to remain unchecked, sundown towns in the Midwest, and segregation in communities across the country , which would be reinforced by
3240-488: A prominent leader in the early 1960s. The Great Society plan of President Lyndon Johnson 's administration resulted in groundbreaking and broad-reaching laws, policies and a constitutional amendment to counteract some of the worst effects of lingering institutional racism . The counterculture movement in the U.S. brought significant social changes, including the liberalization of attitudes toward recreational drug use and sexuality . It also encouraged open defiance of
3402-536: A provision for additional coverage of skilled nursing care in the indemnity insurance policies they sell or health plans they sponsor. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 90-day hospital clock and 100-day nursing home clock are reset and the person qualifies for new benefit periods. Hospice benefits are also provided under Part A of Medicare for terminally ill persons with less than six months to live, as determined by
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#17331159986193564-518: A sense of manifest destiny . The Missouri Compromise attempted to balance the desire of northern states to prevent the expansion of slavery into new territories with that of southern states to extend it, admitting Missouri as a slave state and Maine as a free state. It further prohibited slavery in all other lands of the Louisiana Purchase north of the 36°30′ parallel . As Americans expanded further into land inhabited by Native Americans,
3726-534: A transplant may qualify for Medicare, regardless of age. Individuals diagnosed with ALS are automatically enrolled in Medicare Parts A and B the month their disability benefits begin. Medicare has four parts: Part A, B, C, & D. Coverage under the first two (Parts A and B), as opposed to Part C plans, is referred to as Original Medicare . In April 2018, CMS began mailing out new Medicare cards with new ID numbers to all beneficiaries. Previous cards had ID numbers containing beneficiaries' Social Security numbers ;
3888-401: A year). Juvenile correctional facilities are operated by local or state governments and serve as longer-term placements for any minor adjudicated as delinquent and ordered by a judge to be confined. As of January 2023, the United States has the sixth-highest per capita incarceration rate in the world—531 people per 100,000 inhabitants—and the largest prison and jail population in
4050-487: Is "held harmless" from the 2019 amount if the increase in their SS monthly benefit does not cover the increase in their Part B premium from 2019 to 2020. This hold harmless provision is significant in years when SS does not increase but that is not the case for 2020. There are additional income-weighted surtaxes for those with incomes more than $ 85,000 per annum. Public Part C Medicare Advantage and other Part C health plans are required to offer coverage that meets or exceeds
4212-578: Is a non-profit health insurance company headquartered in Rochester, New York . It is part of the Blue Cross Blue Shield Association. In 2010, Excellus was Upstate New York 's largest nonprofit health plan. In 2001, Excellus merged with Univera Healthcare , (formerly North AmeriCare ), based in Buffalo, New York . Univera retained its name and is separate from Excellus BCBS. Excellus was
4374-665: Is a name used by an association of health insurance plans throughout the United States . Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice president of Baylor University 's health care facilities in Dallas, Texas . The first plan guaranteed teachers 21 days of hospital care for $ 6 a year, and was later extended to other employee groups in Dallas, and then nationally. The American Hospital Association (AHA) adopted
4536-419: Is agreed upon between the sponsor and the provider. The amounts paid for mostly self-administered drugs under Part D are whatever is agreed upon between the sponsor (almost always through a pharmacy benefit manager also used in commercial insurance) and pharmaceutical distributors and/or manufacturers. Medicare has several sources of financing. Part A's inpatient admitted hospital and skilled nursing coverage
4698-515: Is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state. It donated $ 1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program. In August 2022, more than 12,000 members of Arkansas Blue Cross were affected by a ransomware attack on a former affiliate, North Highland Company, LLC. Blue Cross of Idaho and Regence BlueShield Idaho are separate companies and compete throughout
4860-571: Is believed to be the first widespread culture in the Americas. Over time, indigenous North American cultures grew increasingly sophisticated, and some, such as the Mississippian culture , developed agriculture , architecture , and complex societies . In the post-archaic period , the Mississippian cultures were located in the midwestern , eastern , and southern regions, and the Algonquian in
5022-596: Is called the Income Related Monthly Adjustment Amount (IRMAA). Part A —For each benefit period , a beneficiary pays an annually adjusted: Part B —After beneficiaries meet the yearly deductible of $ 240 for 2024, they will be required to pay a co-insurance of 20% of the Medicare-approved amount for all services covered by Part B with the exception of most lab services, which are covered at 100%. Previously, outpatient mental health services
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5184-745: Is eligible for Part D, which covers mostly self-administered drugs. It was made possible by the passage of the Medicare Modernization Act of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or public Part C health plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by various sponsors including charities, integrated health delivery systems, unions and health insurance companies; almost all these sponsors in turn use pharmacy benefit managers in
5346-478: Is funded by payroll taxes) and premiums paid by beneficiaries. Households that retired in 2013 paid only 13 to 41 percent of the benefit dollars they are expected to receive. Beneficiaries typically have other healthcare-related costs, including Medicare Part A, B and D deductibles and Part B and C co-pays; the costs of long-term custodial care (which are not covered by Medicare); and the costs resulting from Medicare's lifetime and per-incident limits. Originally,
5508-457: Is generally not appropriate; payment such as is approved will be paid under Part B. The time a patient spends in the hospital before an inpatient admission is formally ordered is considered outpatient time. But, hospitals and physicians can take into consideration the pre-inpatient admission time when determining if a patient's care will reasonably be expected to cross two midnights to be covered under Part A. In addition to deciding which trust fund
5670-674: Is headquartered in Providence, Rhode Island . BlueCross BlueShield of the U.S. Virgin Islands is administered by BlueCross BlueShield of Puerto Rico. Blue Cross Blue Shield of Wyoming (BCBSWY) is a non-profit founded in 1945. In 2022, BCBSWY penned opposition to the Pharmacy benefit managers act enhancements (Wyoming Senate File 0036). While only some members retain nonprofit status, the ones that do have been criticized for holding excessive amounts of cash or excessive executive compensation. For instance,
5832-492: Is known as the presidential system , in contrast to the parliamentary system , where the executive is part of the legislative body. Many countries around the world imitated this aspect of the 1789 Constitution of the United States , especially in the Americas. The Constitution is silent on political parties. However, they developed independently in the 18th century with the Federalist and Anti-Federalist parties. Since then,
5994-403: Is largely funded by revenue from a 2.9% payroll tax levied on employers and workers (each pay 1.45%). Until December 31, 1993, the law provided a maximum amount of compensation on which the Medicare tax could be imposed annually, in the same way that the Social Security payroll tax operates. Beginning on January 1, 1994, the compensation limit was removed. Self-employed individuals must calculate
6156-506: Is no longer offered as of 2020, but anyone who has a Plan F may keep it. Many of the insurance companies that offer Medigap insurance policies also sponsor Part C health plans but most Part C health plans are sponsored by integrated health delivery systems and their spin-offs, charities, and unions as opposed to insurance companies. Medicare contracts with regional insurance companies to process over one billion fee-for-service claims per year. In 2008, Medicare accounted for 13% ($ 386 billion) of
6318-438: Is now the United States experienced conflicts with Native Americans, they also engaged in trade, exchanging European tools for food and animal pelts. Relations ranged from close cooperation to warfare and massacres. The colonial authorities often pursued policies that forced Native Americans to adopt European lifestyles, including conversion to Christianity. Along the eastern seaboard, settlers trafficked African slaves through
6480-542: Is the federal agency charged with addressing most environmental-related issues . The idea of wilderness has shaped the management of public lands since 1964, with the Wilderness Act . The Endangered Species Act of 1973 provides a way to protect threatened and endangered species and their habitats. The United States Fish and Wildlife Service implements and enforces the Act. In 2024, the U.S. ranked 34th among 180 countries in
6642-402: Is the same no matter how much or how little the beneficiary paid as long as the minimum number of quarters is reached. Medicare-eligible persons who do not have 40 or more quarters of Medicare-covered employment may buy into Part A for an annual adjusted monthly premium of: Most Medicare Part B enrollees pay an insurance premium for this coverage; the standard Part B premium for 2019 is $ 135.50
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6804-463: Is used to pay for these various outpatient versus inpatient charges, the number of days for which a person is formally considered an admitted patient affects eligibility for Part A skilled nursing services. Medicare penalizes hospitals for readmissions . After making initial payments for hospital stays, Medicare will take back from the hospital these payments, plus a penalty of 4 to 18 times the initial payment, if an above-average number of patients from
6966-569: The Allies , helping to turn the tide against the Central Powers . In 1920, a constitutional amendment granted nationwide women's suffrage . During the 1920s and '30s, radio for mass communication and the invention of early television transformed communications nationwide. The Wall Street Crash of 1929 triggered the Great Depression , which President Franklin D. Roosevelt responded to with
7128-488: The American Medical Association , advises the government about pay standards for Medicare patient procedures performed by doctors and other professionals under Medicare Part B. A similar but different CMS process determines the rates paid for acute care and other hospitals—including skilled nursing facilities—under Medicare Part A. The rates paid for both Part A and Part B type services under Part C are whatever
7290-548: The Atlantic slave trade . The original Thirteen Colonies that would later found the United States were administered as possessions of Great Britain , and had local governments with elections open to most white male property owners . The colonial population grew rapidly, eclipsing Native American populations; by the 1770s, the natural increase of the population was such that only a small minority of Americans had been born overseas. The colonies' distance from Britain allowed for
7452-580: The Baby Boom generation into Medicare is projected by 2030 (when the last of the baby boom turns 65) to increase enrollment to more than 80 million. In addition, the fact that the number of payroll tax payors per enrollee will decline over time and that overall health care costs in the nation are rising pose substantial financial challenges to the program. Medicare spending is projected to increase from near 4% of GDP in 2022 to almost 6% in 2046. Baby-boomers are projected to have longer life spans, which will add to
7614-773: The Bering land bridge more than 12,000 years ago, and formed various civilizations and societies . British colonization led to the first settlement of the Thirteen Colonies in Virginia in 1607. Clashes with the British Crown over taxation and political representation sparked the American Revolution , with the Second Continental Congress formally declaring independence on July 4, 1776. Following its victory in
7776-567: The Blue Cross and Blue Shield Association (BCBS). Prior to 1986, organizations administering BCBS were tax exempt under 501(c) (4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation, but entitled to "special tax benefits" under IRC 833. In 1994, BCBS changed to allow its licensees to be for-profit corporations. During 2010, Health Care Service Corporation ,
7938-462: The Chicago Loop area of Chicago, Illinois. Single-state members include the following organizations. Blue Cross Blue Shield of Arizona (BCBSAZ) is a non-profit healthcare organization founded in 1939. BCBSAZ partners with non-profit "Discovery Triangle Development Corporation" to launch a Farm Express mobile market (formerly Fresh Express). Founded in 1948, Arkansas Blue Cross Blue Shield (ABCBS)
8100-529: The Environmental Performance Index . The country joined the Paris Agreement on climate change in 2016 and has many other environmental commitments. The United States is a federal republic of 50 states and a separate federal capital district, Washington, D.C. It also asserts sovereignty over five unincorporated territories and several uninhabited island possessions . The U.S. is
8262-493: The Federal Bureau of Investigation (FBI) and the U.S. Marshals Service have national jurisdiction and specialized duties, such as protecting civil rights , national security and enforcing U.S. federal courts ' rulings and federal laws. State courts conduct most civil and criminal trials, and federal courts handle designated crimes and appeals of state court decisions . There is no unified "criminal justice system" in
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#17331159986198424-556: The Federal Employees Health Benefits Program (FEHB) for U.S. federal government employees and retirees, and has been part of FEHB since FEHB's inception in 1960. FEP enrolls over half of the federal workforce, with over 5 million members, making it the largest insurer of federal employees and the largest single health plan group in the world. The association is headquartered in the Michigan Plaza complex in
8586-514: The Federal Employees Health Benefits Program Standard Option. Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare. Most Medicare enrollees do not pay a monthly Part A premium, because they (or a spouse) have had 40 or more 3-month quarters in which they paid Federal Insurance Contributions Act taxes. The benefit
8748-688: The Great Lakes , Mississippi River and Gulf of Mexico . British colonization of the East Coast began with the Virginia Colony (1607) and Plymouth Colony (1620). The Mayflower Compact and the Fundamental Orders of Connecticut established precedents for representative self-governance and constitutionalism that would develop throughout the American colonies. While European settlers in what
8910-701: The Great Lakes region and along the Eastern Seaboard , while the Hohokam culture and Ancestral Puebloans inhabited the southwest . Native population estimates of what is now the United States before the arrival of European immigrants range from around 500,000 to nearly 10 million. Christopher Columbus began exploring the Caribbean for Spain in 1492, leading to Spanish-speaking settlements and missions from Puerto Rico and Florida to New Mexico and California . France established its own settlements along
9072-583: The House of Representatives , a lower house based on population; and the Senate , an upper house based on equal representation for each state. Federalism provides substantial autonomy to the 50 states, while American values are based on a democratic political tradition that draws its inspiration from the European Enlightenment movement . One of the world's most developed countries , the United States has had
9234-580: The Midwest . At the same time, about one million French Canadians migrated from Quebec to New England . During the Great Migration , millions of African Americans left the rural South for urban areas in the North. Alaska was purchased from Russia in 1867. The Compromise of 1877 effectively ended Reconstruction and white supremacists took local control of Southern politics . African Americans endured
9396-672: The National Park Service and other agencies. About 28% of the country's land is publicly owned and federally managed, primarily in the Western States . Most of this land is protected , though some is leased for commercial use, and less than one percent is used for military purposes. Environmental issues in the United States include debates on non-renewable resources and nuclear energy , air and water pollution , biodiversity , logging and deforestation , and climate change . The U.S. Environmental Protection Agency (EPA)
9558-634: The New Deal , a series of sweeping programs and public works projects combined with financial reforms and regulations . All were intended to protect against future economic depressions. Initially neutral during World War II , the U.S. began supplying war materiel to the Allies of World War II in March 1941 and entered the war in December after the Empire of Japan 's attack on Pearl Harbor . The U.S. developed
9720-759: The Organization of American States and the United States–Mexico–Canada Free Trade Agreement . In South America, Colombia is traditionally considered to be the closest ally of the United States. The U.S. exercises full international defense authority and responsibility for Micronesia , the Marshall Islands , and Palau through the Compact of Free Association . It has increasingly conducted strategic cooperation with India , but its ties with China have steadily deteriorated. Since 2014,
9882-638: The Pentium microprocessor in accordance with Moore's law , rechargeable lithium-ion batteries , the first gene therapy trial, and cloning either emerged in the U.S. or were improved upon there. The Human Genome Project was formally launched in 1990, while Nasdaq became the first stock market in the United States to trade online in 1998. In the Gulf War of 1991, an American-led international coalition of states expelled an Iraqi invasion force that had occupied neighboring Kuwait . The September 11 attacks on
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#173311599861910044-418: The Soviet Union's collapse and the end of the Cold War in 1991, the U.S. emerged as the world's sole superpower , wielding significant geopolitical influence globally . The U.S. national government is a presidential constitutional federal republic and liberal democracy with three separate branches : legislative , executive , and judicial . It has a bicameral national legislature composed of
10206-399: The Spanish–American War . (The Philippines was granted full independence from the U.S. on July 4, 1946, following World War II. Puerto Rico and Guam have remained U.S. territories.) American Samoa was acquired by the United States in 1900 after the Second Samoan Civil War . The U.S. Virgin Islands were purchased from Denmark in 1917. The United States entered World War I alongside
10368-512: The archipelagic Hawaii in the Pacific Ocean . The United States also asserts sovereignty over five major island territories and various uninhabited islands . The country has the world's third-largest land area , largest exclusive economic zone , and third-largest population , exceeding 334 million. Its three largest metropolitan areas are New York , Los Angeles , and Chicago , and its three most populous states are California , Texas , and Florida . Paleo-Indians migrated across
10530-399: The cotton gin made the institution increasingly profitable for Southern elites . This sectional conflict regarding slavery culminated in the American Civil War (1861–1865). Eleven slave states seceded and formed the Confederate States of America , while the other states remained in the Union . War broke out in April 1861 after the Confederates bombarded Fort Sumter . After
10692-413: The fall of communism and the collapse of the Soviet Union , which marked the end of the Cold War and left the United States as the world's sole superpower . The 1990s saw the longest recorded economic expansion in American history , a dramatic decline in U.S. crime rates , and advances in technology . Throughout this decade, technological innovations such as the World Wide Web , the evolution of
10854-435: The federal budget . In 2016 it was projected to account for close to 15% ($ 683 billion) of the total expenditures. For the decade 2010–2019 Medicare was projected to cost 6.4 trillion dollars. For institutional care, such as hospital and nursing home care, Medicare uses prospective payment systems . In a prospective payment system, the health care institution receives a set amount of money for each episode of care provided to
11016-445: The highest disposable household income per capita among OECD countries. As of February 2024, the total federal government debt was $ 34.4 trillion. Medicare (United States) Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). It
11178-445: The largest nominal GDP since about 1890 and accounted for over 15% of the global economy in 2023. It possesses by far the largest amount of wealth of any country and has the highest disposable household income per capita among OECD countries. The U.S. ranks among the world's highest in economic competitiveness , productivity , innovation , human rights , and higher education . Its hard power and cultural influence have
11340-594: The nationwide health insurance program for employees of the United States federal government . BCBSA manages communications between its members and the operating policies required to be a licensee of the trademarks. This permits each BCBSA company to offer nationwide insurance coverage through its BlueCard provider network and claims reimbursement program even though it operates only in its designated service area. Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians' services. Blue Cross
11502-406: The 1775 Battles of Lexington and Concord , igniting the American Revolutionary War . At the Second Continental Congress , the colonies appointed George Washington commander-in-chief of the Continental Army , and created a committee that named Thomas Jefferson to draft the Declaration of Independence . Two days after passing the Lee Resolution to create an independent nation the Declaration
11664-516: The 1775–1783 Revolutionary War , the country continued to expand westward across North America , resulting in the dispossession of native inhabitants . As more states were admitted , a North–South division over slavery led to the secession of the Confederate States of America , which fought states remaining in the Union in the 1861–1865 American Civil War . With the victory and preservation of
11826-421: The 1970s was formalized and expanded under President Bill Clinton in 1997 as Medicare Part C (although not all Part C health plans sponsors have to be HMOs, about 75% are). In 2003, under President George W. Bush , a Medicare program for covering almost all self-administered prescription drugs was passed (and went into effect in 2006) as Medicare Part D. The Centers for Medicare and Medicaid Services (CMS),
11988-515: The 2010s, political polarization in the country increased between liberal and conservative factions. This polarization was capitalized upon in the January 2021 Capitol attack , when a mob of insurrectionists entered the U.S. Capitol and sought to prevent the peaceful transfer of power in an attempted self-coup d'état . The United States is the world's third-largest country by total area behind Russia and Canada. The 48 contiguous states and
12150-627: The Affordable Care Act. In 2022, Medicare spending was over $ 900 billion, near 4% of U.S. gross domestic product according to the Trustees Figure 1.1 and over 15% of total US federal spending. Because of the two Trust funds and their differing revenue sources (one dedicated and one not), the Trustees analyze Medicare spending as a percent of GDP rather than versus the Federal budget. The aging of
12312-580: The American West have an alpine climate . The climate is arid in the Southwest, Mediterranean in coastal California , and oceanic in coastal Oregon , Washington , and southern Alaska . Most of Alaska is subarctic or polar . Hawaii , the southern tip of Florida and U.S. territories in the Caribbean and Pacific are tropical . States bordering the Gulf of Mexico are prone to hurricanes, and most of
12474-915: The Blue Cross Association in 1960, and Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. Its headquarters are at the Aon Center at 200 E. Randolph Street in Chicago , Illinois . BCBSA claims to control access to the Blue Cross and Blue Shield trademarks and names across the United States and in more than 170 other countries, which it then licenses to the affiliated companies for specific, exclusive geographic service areas. It has affiliated plans in all 50 states, Washington, D.C., and Puerto Rico , and licensees offering plans in several foreign countries; it also participates in
12636-524: The Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960, the AHA commission was superseded by the Blue Cross Association. Blue Cross severed its ties with the AHA in 1972. Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. In 1939,
12798-543: The CEO of BCBS Michigan, Daniel Loepp, earned over 19 million USD in 2018, more than the CEO of Ford or Fiat Chrysler during the same year. In 2014, BC/BS of Illinois ( Health Care Service Corporation ) was sued over its nonprofit status. The lawsuit was dismissed, with prejudice , and the dismissal ruling was upheld on appeal. Similar suits occurred with similar results in other states such as Oregon. Conversions into for-profit corporations typically results in distribution of some of
12960-524: The Declaration of Independence on July 4, 1776. The term "United States" and the initialism "U.S.", used as nouns or as adjectives in English, are common short names for the country. The initialism "USA", a noun, is also common. "United States" and "U.S." are the established terms throughout the U.S. federal government , with prescribed rules. In English, the term "America" rarely refers to topics unrelated to
13122-557: The District of Columbia occupy a combined area of 3,119,885 square miles (8,080,470 km ). The coastal plain of the Atlantic seaboard gives way to inland forests and rolling hills in the Piedmont plateau region. The Appalachian Mountains and the Adirondack massif separate the East Coast from the Great Lakes and the grasslands of the Midwest . The Mississippi River System ,
13284-663: The Elder concluded that major military resources needed to be devoted to North America to win the war against France. The British colonies' position as an integral part of the British Empire became more apparent during the war, with British military and civilian officials becoming a more significant presence in American life. Following their victory in the French and Indian War, Britain began to assert greater control over local colonial affairs, resulting in colonial political resistance ; one of
13446-664: The January 1863 Emancipation Proclamation , many freed slaves joined the Union army . The war began to turn in the Union's favor following the 1863 Siege of Vicksburg and Battle of Gettysburg , and the Confederacy surrendered in 1865 after the Union's victory in the Battle of Appomattox Court House . The Reconstruction era followed the war. After the assassination of President Abraham Lincoln , Reconstruction Amendments were passed to protect
13608-623: The Medicare Board of Trustees to assist them in assessing the program's financial health. The Trustees are required by law to issue annual reports on the financial status of the Medicare Trust Funds, and those reports are required to contain a statement of actuarial opinion by the Chief Actuary. The Specialty Society Relative Value Scale Update Committee (or Relative Value Update Committee; RUC), composed of physicians associated with
13770-526: The Medicare program over their lifetimes, and how much someone living to the statistically expected age would expect to receive in benefits. They found differing amounts for the different scenarios, but even the group with the "worst" return on their Medicare taxes would have concluded their working years with $ 158,000 in Medicare contributions and growth (assuming annual growth equal to inflation plus 2%) but would receive $ 385,000 in Medicare benefits (both numbers are in 2013 inflation adjusted dollars). Overall,
13932-479: The Patient Protection and Affordable Care Act of 2010 as amended. The Social Security Administration is responsible for determining Medicare eligibility, eligibility for and payment of Extra Help/Low Income Subsidy payments related to Parts C and D of Medicare, and collecting most premium payments for the Medicare program. The Chief Actuary of the CMS must provide accounting information and cost-projections to
14094-595: The Rocky Mountains, the Yellowstone Caldera , is the continent's largest volcanic feature. In 2021, the United States had 8% of global permanent meadows and pastures and 10% of cropland. With its large size and geographic variety, the United States includes most climate types. East of the 100th meridian , the climate ranges from humid continental in the north to humid subtropical in the south. The western Great Plains are semi-arid . Many mountainous areas of
14256-625: The U.S. has become a key ally of Ukraine ; it has also provided the country with significant military equipment and other support in response to Russia's 2022 invasion . The president is the commander-in-chief of the United States Armed Forces and appoints its leaders, the secretary of defense and the Joint Chiefs of Staff . The Department of Defense , which is headquartered at the Pentagon near Washington, D.C., administers five of
14418-661: The U.S. territories." Despite disparate systems of confinement, four main institutions dominate: federal prisons , state prisons , local jails, and juvenile correctional facilities . Federal prisons are run by the Federal Bureau of Prisons and hold people who have been convicted of federal crimes, including pretrial detainees. State prisons, run by the official department of correction of each state, hold sentenced people serving prison time (usually longer than one year) for felony offenses. Local jails are county or municipal facilities that incarcerate defendants prior to trial; they also hold those serving short sentences (typically under
14580-463: The US average rate. Part A fully covers brief stays for rehabilitation or convalescence in a skilled nursing facility and up to 100 days per medical necessity with a co-pay if certain criteria are met: The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment of $ 204 per day as of 2024. Many insurance group retiree, Medigap and Part C insurance plans have
14742-555: The United States District Court, Western District of Louisiana ruled that "Because Salim showed that PBT was a nationally accepted standard of care for advanced head and neck cancer in 2018, BCBSLA abused its discretion in finding Salim's PBT treatment was not medically necessary." A Propublica investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company called AIM Specialty Health to reject appeals for denial, and that this practice
14904-447: The United States and the peaceful transfer of power . The Louisiana Purchase of 1803 from France nearly doubled the territory of the United States. Lingering issues with Britain remained , leading to the War of 1812 , which was fought to a draw. Spain ceded Florida and its Gulf Coast territory in 1819. In the late 18th century, American settlers began to expand westward , many with
15066-803: The United States entered the Cold War, where geopolitical tensions between the U.S. and the Soviet Union led the two countries to dominate world affairs . The U.S. utilized the policy of containment to limit the USSR's sphere of influence, and prevailed in the Space Race , which culminated with the first crewed Moon landing in 1969. Domestically, the U.S. experienced economic growth , urbanization , and population growth following World War II . The civil rights movement emerged, with Martin Luther King Jr. becoming
15228-649: The United States has operated as a de facto two-party system , though the parties in that system have been different at different times. The two main national parties are presently the Democratic and the Republican . The former is perceived as relatively liberal in its political platform while the latter is perceived as relatively conservative . In the American federal system , sovereign powers are shared between two levels of elected government: national and state. People in
15390-572: The United States in 2001 by the pan-Islamist militant organization al-Qaeda led to the war on terror , and subsequent military interventions in Afghanistan and Iraq . The cultural impact of the attacks was profound and long-lasting. The U.S. housing bubble culminated in 2007 with the Great Recession , the largest economic contraction since the Great Depression. Coming to a head in
15552-631: The United States of America to Spain" to seek assistance in the Revolutionary War effort. The first known public usage is an anonymous essay published in the Williamsburg newspaper, The Virginia Gazette , on April 6, 1776. By June 1776, the "United States of America" appeared in the Articles of Confederation and the Declaration of Independence . The Second Continental Congress adopted
15714-645: The United States, slavery was abolished nationally . By 1900, the country had established itself as a great power , a status solidified after its involvement in World War I . After Japan 's attack on Pearl Harbor in December 1941, the U.S. entered World War II . Its aftermath left the U.S. and the Soviet Union as the world's two superpowers and led to the Cold War , during which both countries struggled for ideological dominance and international influence . Following
15876-532: The United States, despite the usage of "the Americas " as the totality of North and South America. "The States" is an established colloquial shortening of the name, used particularly from abroad; "stateside" is the corresponding adjective or adverb. The first inhabitants of North America migrated from Siberia across the Bering land bridge about 12,000 years ago; the Clovis culture , which appeared around 11,000 BC,
16038-605: The United States, except Iran , North Korea , and Bhutan . Though Taiwan does not have formal diplomatic relations with the U.S., it maintains close unofficial relations. The United States regularly supplies Taiwan with military equipment to deter potential Chinese aggression. Its geopolitical attention also turned to the Indo-Pacific when the United States joined the Quadrilateral Security Dialogue with Australia, India, and Japan. The United States has
16200-509: The United States. The American prison system is largely heterogenous, with thousands of relatively independent systems operating across federal, state, local, and tribal levels. In 2023, "these systems [held] almost 2 million people in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,323 juvenile correctional facilities, 181 immigration detention facilities, and 80 Indian country jails, as well as in military prisons , civil commitment centers, state psychiatric hospitals, and prisons in
16362-513: The assets into a charitable foundation . When Blue Cross of California was converted, it initially had no distribution, but subsequently The California Endowment and California Health Care Foundation were endowed with $ 3.2 billion. Proceeds ranged from $ 3.2 billion (California) to $ 1.5 million (Nevada). An exceptional case occurred in the Empire Blue Cross conversion, where the proceeds went to fund wage increases for union workers. In 2022,
16524-416: The association and traditionally of each other, offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state . They also act as administrators of Medicare in many states or regions of the U.S. The Blue Cross Blue Shield Federal Employee Program (FEP) is a nationwide option under
16686-498: The beneficiary has 60 days continuously with no payment from Medicare for hospital or Skilled Nursing Facility confinement. Some "hospital services" are provided as inpatient services, which would be reimbursed under Part A; or as outpatient services, which would be reimbursed, not under Part A, but under Part B instead. The "Two-Midnight Rule" decides which is which. In August 2013, the Centers for Medicare and Medicaid Services announced
16848-511: The benefits are more limited (but they can never be more limited than Original Medicare and must always include an OOP limit) and there is no premium. The OOP limit can be as low as $ 1500 and as high as but no higher than $ 8000 (as with all insurance, the lower the limit, the higher the premium). In some cases, the sponsor even rebates part or all of the Part B premium, though these types of Part C plans are becoming rare. Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B
17010-618: The conditions with the highest readmission rates were congestive heart failure, sepsis , pneumonia, and COPD and bronchiectasis . The highest penalties on hospitals are charged after knee or hip replacements, $ 265,000 per excess readmission. The goals are to encourage better post-hospital care and more referrals to hospice and end-of-life care in lieu of treatment, while the effect is also to reduce coverage in hospitals that treat poor and frail patients. The total penalties for above-average readmissions in 2013 are $ 280 million, for 7,000 excess readmissions, or $ 40,000 for each readmission above
17172-453: The contiguous United States are in the State of California, about 84 miles (135 km) apart. At an elevation of 20,310 feet (6,190.5 m), Alaska's Denali is the highest peak in the country and continent. Active volcanoes are common throughout Alaska's Alexander and Aleutian Islands , and Hawaii consists of volcanic islands. The supervolcano underlying Yellowstone National Park in
17334-549: The country's GDP. The U.S. has 42% of the world's nuclear weapons —the second-largest share after Russia. The United States has the third-largest combined armed forces in the world, behind the Chinese People's Liberation Army and Indian Armed Forces . The military operates about 800 bases and facilities abroad, and maintains deployments greater than 100 active duty personnel in 25 foreign countries. State defense forces (SDFs) are military units that operate under
17496-464: The country's territory would expand with the admission of new states , rather than the expansion of existing states. The U.S. Constitution was drafted at the 1787 Constitutional Convention to overcome the limitations of the Articles. It went into effect in 1789, creating a federal republic governed by three separate branches that together ensured a system of checks and balances . George Washington
17658-699: The development of self-governance, and the First Great Awakening , a series of Christian revivals , fueled colonial interest in religious liberty . For a century, the American colonists had been providing their own troops and materiel in conflicts with indigenous peoples allied with Britain's colonial rivals , especially France, and the Americans had begun to develop a sense of self-defense and self-reliance separate from Britain. The French and Indian War (1754–1763) took on new significance for all North American colonists after Parliament under William Pitt
17820-418: The entire 2.9% tax on self-employed net earnings (because they are both employee and employer), but they may deduct half of the tax from the income in calculating income tax. Beginning in 2013, the rate of Part A tax on earned income exceeding $ 200,000 for individuals ($ 250,000 for married couples filing jointly) rose to 3.8%, in order to pay part of the cost of the subsidies to people not on Medicare mandated by
17982-530: The entire United States health care delivery system and not just to Medicare. U.S. citizens or permanent residents who have lived in the U.S. for at least five continuous years are eligible. Those who are 65 and older who choose to enroll in Part A Medicare must pay a monthly premium to remain enrolled in Medicare Part A if they or their spouse have not paid the qualifying Medicare payroll taxes. There are some instances where U.S. citezens might be able to enroll in Medicare earlier than age 65. For example, if you have
18144-564: The environment for labor unions to begin to flourish . This period eventually ended with the advent of the Progressive Era , which was characterized by significant reforms. Pro-American elements in Hawaii overthrew the Hawaiian monarchy ; the islands were annexed in 1898. That same year, Puerto Rico , the Philippines , and Guam were ceded to the U.S. by Spain after the latter's defeat in
18306-527: The federal government often applied policies of Indian removal or assimilation . The Trail of Tears (1830–1850) was a U.S. government policy that forcibly removed and displaced most Native Americans living east of the Mississippi River to lands far to the west. These and earlier organized displacements prompted a long series of American Indian Wars west of the Mississippi. The Republic of Texas
18468-590: The first nuclear weapons and used them against the Japanese cities of Hiroshima and Nagasaki in August 1945, ending the war. The United States was one of the " Four Policemen " who met to plan the post-war world , alongside the United Kingdom , Soviet Union , and China . The U.S. emerged relatively unscathed from the war, with even greater economic power and international political influence . After World War II,
18630-609: The first official Blue Shield plan was founded in California. In 1948, the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans. In the 1960s, the U.S. government chose to partner with Blue Cross and Blue Shield companies to administer Medicare . In 1982, Blue Shield merged with The Blue Cross Association to form
18792-525: The first recipients of the program. Before Medicare was created, approximately 60% of people over the age of 65 had health insurance (as opposed to about 70% of the population younger than that), with coverage often unavailable or unaffordable to many others, because older adults paid more than three times as much for health insurance as younger people. Many of this group (about 20% of the total in 2022, 75% of whom were eligible for all Medicaid benefits) became "dual eligible" for both Medicare and Medicaid (which
18954-563: The following protected classes of drugs: anti-cancer; anti-psychotic; anti-convulsant, anti-depressants, immuno-suppressant, and HIV and AIDS drugs). The plans can also specify, with CMS approval, at what level (or tier) they wish to cover it, and are encouraged to use step therapy . Some drugs are excluded from coverage altogether and Part D plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. No part of Medicare pays for all of
19116-624: The forecasting of Medicare Trust Fund health and spending trends including but not limited to the Covid pandemic, the overwhelming preference of people joining Medicare this century for Part C, and the increasing number of dual eligible (Medicaid and Medicare eligibility) beneficiaries. In 2013 the Urban Institute published a report which analyzed the amounts that various households (single male, single female, married single-earner, married dual-earner, low income, average income, high income) contributed to
19278-506: The future Medicare spending. In response to these financial challenges, Congress made substantial cuts to future payouts to providers (primarily acute care hospitals and skilled nursing facilities) as part of PPACA in 2010 and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and individual Congresspeople have offered many additional competing proposals to stabilize Medicare spending further. Many other factors have complicated
19440-460: The group of 34 companies that make up the BCBS Association settled an antitrust investigation by allowing competition among member companies under non-Blue names while retaining regional exclusivity for regional licenses. In 2018 Robert Salim was diagnosed with stage 4 throat cancer, however the proton therapy ordered by his doctor was denied by Blue Cross Blue Shield. Salim sued. In July 2022
19602-637: The groups paid into the system 13 to 41 percent of what they were expected to receive. Cost reduction is influenced by factors including reduction in inappropriate and unnecessary care by evaluating evidence-based practices as well as reducing the amount of unnecessary, duplicative, and inappropriate care. Cost reduction may also be effected by reducing medical errors, investment in healthcare information technology , improving transparency of cost and quality data, increasing administrative efficiency, and by developing both clinical/non-clinical guidelines and quality standards. Of course all of these factors relate to
19764-483: The hospital are readmitted within 30 days. These readmission penalties apply after some of the most common treatments: pneumonia , heart failure , heart attack , COPD , knee replacement , and hip replacement . A study of 18 states conducted by the Agency for Healthcare Research and Quality (AHRQ) found that 1.8 million Medicare patients aged 65 and older were readmitted within 30 days of an initial hospital stay in 2011;
19926-402: The hospital for defamation. Blue Cross Blue Shield of Nebraska was founded in 1939. On July 1, 2018, BCBS Nebraska formed GoodLife Partners Inc., a mutual holding company, to conduct its noninsurance businesses. The company retained the Blue Cross brand, converting from mutual ownership to a stock company wholly owned by GoodLife. Excellus BlueCross BlueShield ( Excellus BCBS , or Excellus )
20088-463: The integration of Army National Guard units and personnel into the U.S. Army and (since 1947) the U.S. Air Force. There are about 18,000 U.S. police agencies from local to national level in the United States. Law in the United States is mainly enforced by local police departments and sheriff departments in their municipal or county jurisdictions. The state police departments have authority in their respective state , and federal agencies such as
20250-697: The leadership of President Lyndon Johnson , Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. Johnson signed the Social Security Amendments of 1965 into law on July 30, 1965, at the Harry S. Truman Presidential Library in Independence, Missouri . Former President Harry S. Truman and his wife, former First Lady Bess Truman became
20412-477: The military draft (leading to the end of conscription in 1973) and wide opposition to U.S. intervention in Vietnam (with the U.S. totally withdrawing in 1975). A societal shift in the roles of women was significantly responsible for the large increase in female paid labor participation during the 1970s, and by 1985 the majority of American women aged 16 and older were employed. The late 1980s and early 1990s saw
20574-612: The most attractive to the population are the most vulnerable. The U.S. is one of 17 megadiverse countries containing large numbers of endemic species : about 17,000 species of vascular plants occur in the contiguous United States and Alaska, and over 1,800 species of flowering plants are found in Hawaii, few of which occur on the mainland. The United States is home to 428 mammal species, 784 birds, 311 reptiles, 295 amphibians , and around 91,000 insect species. There are 63 national parks , and hundreds of other federally managed parks, forests, and wilderness areas , managed by
20736-642: The most violent, the California genocide of thousands of Native inhabitants, lasted into the early 1870s, just as additional western territories and states were created. During the colonial period, slavery had been legal in the American colonies , though the practice began to be significantly questioned during the American Revolution. States in the North enacted abolition laws , though support for slavery strengthened in Southern states , as inventions such as
20898-544: The name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956. President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed. Various attempts were made in Congress to pass
21060-399: The new ID numbers are randomly generated and not tied to any other personally identifying information . Part A covers inpatient hospital stays. The maximum length of stay that Medicare Part A covers in a hospital admitted inpatient stay or series of stays is typically 90 days. The first 60 days would be paid by Medicare in full, except one copay (also and more commonly referred to as
21222-617: The option of payments to health maintenance organizations (HMOs) in the 1970s. The government added hospice benefits to aid elderly people on a temporary basis in 1982, and made this permanent in 1984. Congress further expanded Medicare in 2001 to cover younger people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease). As the years progressed, Congress expanded Medicare eligibility to younger people with permanent disabilities who receive Social Security Disability Insurance (SSDI) payments and to those with end-stage renal disease (ESRD). The association with HMOs that began in
21384-539: The parent company of BCBS in Texas, Oklahoma, New Mexico, Montana and Illinois, nearly doubled its income to $ 1.09 billion in 2010, and began four years of billion-dollar profits. In the final spending bill for FY 2015 after much lobbying since 2010, nonprofit Blue Cross and Blue Shield plans continue to have special tax breaks that were understood to be threatened by the Affordable Care Act of 2010. Blue Cross and Blue Shield insurance companies are licensees , independent of
21546-477: The patient's physician. The terminally ill person must sign a statement that hospice care has been chosen over other Medicare-covered benefits, (e.g. assisted living or hospital care). Treatment provided includes pharmaceutical products for symptom control and pain relief as well as other services not otherwise covered by Medicare such as grief counseling . Hospice is covered 100% with no co-pay or deductible by Medicare Part A except that patients are responsible for
21708-408: The policy of redlining later adopted by the federal Home Owners' Loan Corporation . An explosion of technological advancement accompanied by the exploitation of cheap immigrant labor led to rapid economic expansion during the late 19th and early 20th centuries , allowing the United States to outpace the economies of England, France, and Germany combined. This fostered the amassing of power by
21870-553: The primary colonial grievances was a denial of their rights as Englishmen , particularly the right to representation in the British government that taxed them . To demonstrate their dissatisfaction and resolve, the First Continental Congress met in 1774 and passed the Continental Association , a colonial boycott of British goods that proved effective. The British attempt to then disarm the colonists resulted in
22032-413: The remaining costs by taking additional private insurance (medi-gap insurance), by enrolling in a Medicare Part D prescription drug plan, or by joining a private Medicare Part C (Medicare Advantage) plan. In 2022, spending by the Medicare Trustees topped $ 900 billion per the Trustees report Table II.B.1, of which $ 423 billion came from the U.S. Treasury and the rest primarily from the Part A Trust Fund (which
22194-515: The rights of African Americans . National infrastructure, including transcontinental telegraph and railroads , spurred growth in the American frontier . From 1865 through 1917 an unprecedented stream of immigrants arrived in the United States, including 24.4 million from Europe. Most came through the port of New York City , and New York City and other large cities on the East Coast became home to large Jewish , Irish , and Italian populations, while many Germans and Central Europeans moved to
22356-437: The rocky Great Basin and Chihuahua , Sonoran , and Mojave deserts. In the northwest corner of Arizona , carved by the Colorado River over millions of years, is the Grand Canyon , a steep-sided canyon and popular tourist destination known for its overwhelming visual size and intricate, colorful landscape. The Sierra Nevada and Cascade mountain ranges run close to the Pacific coast . The lowest and highest points in
22518-408: The same services as Parts A and B, usually with additional benefits. In 2022, Medicare provided health insurance for 65.0 million individuals—more than 57 million people aged 65 and older and about 8 million younger people. According to annual Medicare Trustees reports and research by Congress' MedPAC group, Medicare covers about half of healthcare expenses of those enrolled. Enrollees cover most of
22680-401: The same way as they are used by sponsors of health insurance for those not on Medicare. Unlike Original Medicare (Part A and B), Part D coverage is not standardized (though it is highly regulated by the Centers for Medicare and Medicaid Services). Plans choose which drugs they wish to cover (but must cover at least two drugs in 148 different categories and cover all or "substantially all" drugs in
22842-464: The six service branches, which are made up of the U.S. Army , Marine Corps , Navy , Air Force , and Space Force . The Coast Guard is administered by the Department of Homeland Security in peacetime and can be transferred to the Department of the Navy in wartime. The United States spent $ 916 billion on its military in 2023, which is by far the largest amount of any country , making up 37% of global military spending and accounting for 3.4% of
23004-407: The sole authority of a state government. SDFs are authorized by state and federal law but are under the command of the state's governor . They are distinct from the state's National Guard units in that they cannot become federalized entities. A state's National Guard personnel, however, may be federalized under the National Defense Act Amendments of 1933 , which created the Guard and provides for
23166-588: The standards set by Original Medicare but they do not have to cover every benefit in the same way (the plan must be actuarially equivalent to Original Medicare benefits). After approval by the Centers for Medicare and Medicaid Services, if a Part C plan chooses to cover less than Original Medicare for some benefits, such as Skilled Nursing Facility care, the savings may be passed along to consumers by offering even lower co-payments for doctor visits (or any other plus or minus aggregation approved by CMS). Public Part C Medicare Advantage health plan members typically also pay
23328-473: The state. Blue Cross and Blue Shield of Kansas (BCBSKS) was founded in 1942 by Sam Bartham, later becoming an independent licensee of the Blue Cross Blue Shield Association. Blue Cross Blue Shield of Louisiana is a tax-paying non-profit that was founded in 1934 in New Orleans . An independent licensee of the BCBSA, it is a privately held mutual company without shareholders, which is wholly owned by its policyholders. Blue Cross Blue Shield of Minnesota (BCBSMN)
23490-543: The states are also represented by local elected governments , which are administrative divisions of the states. States are subdivided into counties or county equivalents , and further divided into municipalities . The District of Columbia is a federal district containing the U.S. capital, Washington, D.C. . The federal district is an administrative division of the federal government. Federally recognized tribes govern 326 Indian reservations . The United States has an established structure of foreign relations, and it has
23652-451: The structure and responsibilities of the national federal government and its relationship with the individual states. The U.S. Constitution is the world's oldest national constitution still in effect (from March 4, 1789). Composed of three branches, all headquartered in Washington, D.C., the federal government is the national government of the United States. It is regulated by a strong system of checks and balances . The three-branch system
23814-795: The target of a cyberattack in 2015, in which 10.5 million records were hacked, and cost the company 17.5 million dollars. The company's Blue Cross Blue Shield subsidiaries have been known as: By September 2010, BCBS licensee Blue Cross and Blue Shield of North Carolina announced that it would refund $ 156 million to their policyholders following documented charges: they had been sued and fined for denying due medical treatments to their customers and for underpaying doctors. As of 2019 they were overseeing well over half of all payments for medical services in their state. BCBSNC invests in chronic and underlying condition research, telehealth and artificial intelligence (AI) for digital healthcare . In 2019, Blue Cross and Blue Shield of North Carolina agreed to enter into
23976-406: The world's fourth-longest river system , runs predominantly north–south through the heart of the country. The flat and fertile prairie of the Great Plains stretches to the west, interrupted by a highland region in the southeast. The Rocky Mountains , west of the Great Plains, extend north to south across the country, peaking at over 14,000 feet (4,300 m) in Colorado . Farther west are
24138-449: The world's second-largest diplomatic corps as of 2024 . It is a permanent member of the United Nations Security Council , and home to the United Nations headquarters . The United States is a member of the G7 , G20 , and OECD intergovernmental organizations. Almost all countries have embassies and many have consulates (official representatives) in the country. Likewise, nearly all countries host formal diplomatic missions with
24300-444: The world's oldest surviving federation, and its presidential system of national government has been adopted, in whole or in part, by many newly independent states worldwide following their decolonization . It is a liberal representative democracy "in which majority rule is tempered by minority rights protected by law ". The Constitution of the United States serves as the country's supreme legal document , also establishing
24462-423: The world's tornadoes occur in the country , mainly in Tornado Alley . Overall, the United States receives more high-impact extreme weather incidents than any other country. Extreme weather became more frequent in the U.S. in the 21st century, with three times the number of reported heat waves as in the 1960s. In the American Southwest , droughts became more persistent and more severe. The regions considered as
24624-442: The world, with almost 2 million people incarcerated . An analysis of the World Health Organization Mortality Database from 2010 showed U.S. homicide rates "were 7 times higher than in other high-income countries, driven by a gun homicide rate that was 25 times higher". The U.S. has been the world's largest economy nominally since about 1890 . The 2023 nominal U.S. gross domestic product (GDP) of more than $ 27 trillion
24786-458: Was annexed in 1845, and the 1846 Oregon Treaty led to U.S. control of the present-day American Northwest . Victory in the Mexican–American War resulted in the 1848 Mexican Cession of California, Nevada, Utah, and much of present-day Colorado and the American Southwest . The California gold rush of 1848–1849 spurred a huge migration of white settlers to the Pacific coast, leading to even more confrontations with Native populations. One of
24948-703: Was adopted on July 4, 1776. The political values of the American Revolution included liberty , inalienable individual rights ; and the sovereignty of the people ; supporting republicanism and rejecting monarchy , aristocracy , and all hereditary political power; civic virtue ; and vilification of political corruption . The Founding Fathers of the United States , who included Washington, Jefferson, John Adams , Benjamin Franklin , Alexander Hamilton , John Jay , James Madison , Thomas Paine , and many others, were inspired by Greco-Roman , Renaissance , and Enlightenment philosophies and ideas. The Articles of Confederation were ratified in 1781 and established
25110-464: Was begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS). Medicare is divided into four Parts: A, B, C and D. Part A covers hospital, skilled nursing, and hospice services. Part B covers outpatient services. Part D covers self-administered prescription drugs. Part C is an alternative that allows patients to choose private plans with different benefit structures that provide
25272-725: Was covered at 50%, but under the Medicare Improvements for Patients and Providers Act of 2008 , it gradually decreased over several years and now matches the 20% required for other services. They are also required to pay an excess charge of 15% for services rendered by physicians who do not accept assignment. The deductibles, co-pays, and coinsurance charges for Part C and D plans vary from plan to plan. All Part C plans include an annual out-of-pocket (OOP) upper spend limit. Original Medicare does not include an OOP limit. All insurance companies that sell Medigap policies are required to make Plan A available, and if they offer any other policies, they must also make either Plan C available as well. Plan F
25434-487: Was created by the same 1965 law). In 1966, Medicare spurred the racial integration of thousands of waiting rooms, hospital floors, and physician practices by making payments to health care providers conditional on desegregation . Medicare has been operating for almost 60 years and, during that time, has undergone several major changes. Since 1965, the program's provisions have expanded to include benefits for speech, physical, and chiropractic therapy in 1972. Medicare added
25596-404: Was elected the country's first president under the Constitution, and the Bill of Rights was adopted in 1791 to allay skeptics' concerns about the power of the more centralized government. His resignation as commander-in-chief after the Revolutionary War and his later refusal to run for a third term as the country's first president established a precedent for the supremacy of civil authority in
25758-403: Was founded in 1933, with 3,500 employees reported in 2022. Blue Cross Blue Shield of Mississippi (BCBSMS) was formed as a privately held company in 1954. In 1948, it was converted to a non-profit. In 1973, its name was changed from Mississippi Hospital and Medical Service to Blue Cross & Blue Shield of Mississippi, Inc., which, in 1996, was converted from a non-profit membership corporation to
25920-424: Was the highest in the world, constituting over 25% of the global economy or 15% at purchasing power parity (PPP). From 1983 to 2008, U.S. real compounded annual GDP growth was 3.3%, compared to a 2.3% weighted average for the rest of the G7 . The country ranks first in the world by nominal GDP , second when adjusted for purchasing power parities (PPP), and ninth by PPP-adjusted GDP per capita . It possesses
26082-426: Was uncertainty over whether this bill would pass the House, however, as White House aide Henry Wilson's tally of House members’ votes on a conference bill that included Medicare “disclosed 180 “reasonably certain votes for Medicare, 29 “probable/possible,” 222 “against,” and 4 seats vacant.” Following the 1964 elections however, pro-Medicare forces obtained 44 votes in the House and 4 in the Senate. In July 1965, under
26244-415: Was widespread. United States The United States of America ( USA ), commonly known as the United States ( U.S. ) or America , is a country primarily located in North America . It is a federal union of 50 states and a federal capital district, Washington, D.C. The 48 contiguous states border Canada to the north and Mexico to the south, with the states of Alaska to the northwest and
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