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In the PPACA legislation of 2010, a surtax was added to the Part D premium for higher income seniors to partially fund PPACA and the number of Part B beneficiaries subject to the 2006 surtax was doubled, also partially to fund PPACA.Parts A and B/D use separate trust funds to receive and disburse the funds mentioned above.Before Medicare's creation, approximately 60% of those over 65 had health insurance, 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 latter group (about 20% of the total in 2015) became "dual eligible" for both Medicare and Medicaid with the passage of the law.Self-employed individuals must pay the entire 2.9% tax on self-employed net earnings (because they are both employee and employer), but 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 US0,000 for individuals (US0,000 for married couples filing jointly) rose to 3.8%, in order to pay part of the cost of the subsidies mandated by the PPACA.

Since the beginning of the Medicare program, CMS (that was not always the name of the responsible bureaucracy) has contracted with private insurance companies to operate as intermediaries between the government and medical providers to administer Part A and Part B benefits.

Until December 31, 1993, the law provided a maximum amount of compensation on which the Medicare tax could be imposed each year, in the same way that the Social Security tax works in the United States.

Beginning January 1, 1994, the compensation limit was removed.

There are separate lines for basic Part A and Part B's supplementary medical coverage, each with its own date.

There are no lines for Part C or D, for which additional supplemental policies are issued with a separate card.

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