Medicare's History Explained


Medicare has a long history. We have simplified it for you. Learn how and why Medicare Advantage was created.

1. Year 1945
- President Harry Truman pushes for a national health plan.

2. Year 1965
- Medicare signed into law.
- Harry Truman is Medicare's first enrollee.
- Generally, Medicare paid 80% of medical bills.
- Medicare Supplement paid 20%.
- Over the next 30 years, Medicare Supplements became very
   expensive.

3. Year 1997
- Balanced Budget Act introduces Medicare Part C (Medicare
   Advantage plans). This included HMO's, PPO's, and PFFS's.
- The Medicare HMO (Health Maintenance Organization) is
   first to be offered.
- HMO's main advantage? It is very low priced.
- Reason: Government paid a subsidy to the insurance
   companies so they can offer low premiums and still pay
   claims.
- HMO's main disadvantage? Restricted to a small area of
   service. In addition, generally only worked well in
   populated areas.

4. Late 1990's
- PPO (Preferred Provider Organization) are now offered.
- PPO advantage:
  a. Medium premium with a little more freedom of choice.
  b. Government still pays a subsidy to the insurance
      companies so they can offer lower premiums and pay
      claims.
  c. The main difference between a PPO and a HMO is that
      seniors could now go out of service area but if they did
      they had to pay part of the bill. Sometimes quite a bit.
- PPO disadvantage? Still restricted to small area of service
   and only worked well in populated areas.

5. Year 2003
- PFFS (Private Fee For Service) start being offered.
- PFFS advantages:
  a. Very low premium and in MANY cases a ZERO premium.
  b. Seniors can go to any doctor, any hospital, anywhere in
      the United States that accept the PFFS plan.
  c. No restricted areas of service.
  d. Great for snow birds or travelers (or anyone that enjoys
      total freedom of choice)!
  e. Plan pays FULL Medicare benefits.
  f. Government also pays a subsidy to the insurance
     companies offering these plans, so they can offer lower
     premiums and pay claims.
- PFFS disadvantages: None that we can see.

6. Year 2007
- Government makes MA Plans very attractive.
- Government increases payments to insurance companies
   offering PFFS plans to about $10,000 per enrollee per year.
- This has allowed some PFFS plans to offer VERY LOW
   rates, and in some areas, even offer a ZERO premium.

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