History Of Medicare

Harry Truman

1960

Great Society

Medicare Part A

Medicare Part B

Social Security Amendments of 1965

Those 65 and older and their dependents. It was extended a few years later, through the Social Security Amendments of 1972, to those under age 65 who had been disabled for two years and those with end-stage renal failure. It was designed to pay only the greater portion of a recipient's needs and was never intended to cover the full cost of one's care. It was a "fee-for-service" plan where recipients could receive care from any provider who took Medicare's payments according to a set fee schedule determined by Medicare and had various deductibles and coinsurance provisions.

Medigap, also known as Medicare Supplement Insurance (Med Supp), which covers some of the costs that Medicare does not cover like coinsurance, co-payments, deductibles and some preventative care.

HMO's - Health Maintenance Organizations also known as "managed care" which embraces the concept of coordinating all health care services an individual receives to maximize benefits and minimize costs.

Tax Equity and Fiscal Responsibility act of 1982

Prospective Payment System where reimbursement rates to hospitals are set and based on a system of Diagnostic Related Groups (DRGs) or codes (reasons recipients enter a hospital). There are now over 100,000 codes.

Medicare Part C (originally known as Medicare+Choice) divided the Medicare program into a number of financiang and delivery systems - the "choice" in Medicare+Choice, which include PPOs (preferred provider organization), PFFS (private fee-for-service plans, PSOs (provider-sponsored organizations), MSAs (high-deductible medical savings accounts), fraternal plans. A Medicare+Choice plan has to equal or better the benefits available through Original Medicare.

Centers for Medicare and Medicaid Services (CMS) which operates under the Department of Health and Human Services of the U.S. government

(1) The traditional fee-for-service Medicare program, comprised of Parts A & B, was renamed Original Medicare. (2) The Medicare Part C program, Medicare+Choice, was renamed Medicare Advantage (MA). (3) Medicare Part D for prescription drug coverage was introduced. (4) MAPD - Medicare Advantage plans that include prescription drug coverage (5) PDP - Stand-alone prescription drug plans that are sold outside of Medicare Advantage programs.

Medicare Advantage programs that are intended to deliver, at a minimum, all of the benefits that Original Medicare delivers. This terminology distinguishes MA plans from Medicare supplement insurance (Medigap), which supplements Original Medicare.

Medicare Advantage (MA)

Prescription drug coverage

Medicare Advantage plans that include Prescription Drug Coverage

Stand alone Prescription Drug Plans

Centers for Medicare and Medicaid Services

CMS uses this terminology to refer to Medicare Advantage programs which are intended to deliver, at a minimum, all of the benefits that Original Medicare delivers. *This terminology distinguishes MA plans from Medicare supplement insurance (Medigap), which supplements Original Medicare.

... a voluntary prescription drug benefit plan that is government-sponsored and helps consumers pay for the cost of their prescription medicines.

Creating a new Medicare marketplace by expanding the choices for access to covered services and care, which moved more Medicare recipients into managed care plans.

MMA 2003 created regional provider organizations (RPPOs)

"benchmark"

Employers would drop retirees from their group medical plans once "stand-alone" prescription drug plans became available. MMA 2003 included significant financial incentive for employers to continue to provide group coverage, including prescription drugs, to their age-65-and-over retirees.

Part D - Therefore, all benefits relating to prescription drugs were removed from Medicare supplement plans.

Low-income Medicare recipients have greater and easier access to the various Medicare and Medicaid programs designed for them. I made it easier to qualify for the low-income subsidy (Extra Help) program for Part D prescription drugs and eased the asset test for Medicare Savings Programs that help low-income individuals pay for various out-of-pocket costs not covered by Medicare.

A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following: An institutionalized individual, A dual eligible (have both Medicare and Medicaid, or An individual with a severe or disabling chronic condition, as specified by CMS. If the patient's financial conditions improve, he or she can be disenrolled from the SNP.

Implementation of modifications made by the NAIC to standard Medicare supplement policies and restructuring the current policy offerings and their benefits was introduced June 1, 2010.

Create provider networks and to implement the same quality improvement programs as local PPOs - meaning that a client in an MA PFFS plan can go to any provider who accepts Medicare and who accepts the plan's terms of payment.

A graduated higher Medicare payment schedule for mental health benefits.

For 18 months a competitive bidding program involving medical supplies and durable medical equipment.

To the way medical care is to be delivered in the United States. It deals with health care delivery and payment changes mostly with Medicare Advantage and Medicare Part D. 1) A new payment structure for MA companies provides for a bonus payment of up to 5% for plans that receive four or more stars in the CMS (Centers for Medicare and Medicaid Services) star rating system.

2) MA plans must maintain a medical loss ratio (MLR) of 85% (meaning that 85% of premium revenue must be directed toward enrollee benefits as opposed to overhead or admin.).

3) The open enrollment period for Medicare Advantage and Medicare Part D plan used to run from Nov. 15 - Dec. 30 of every year but now runs from Oct. 15 - Dec. 7. It is called the Annual Coordinated Election Period, the Annual Election Period, or the Open Enrollment Period.

4) An individual who enrolls in an MA plan may return to Original Medicare and a Part D plan during the first 90 days of a new year. This period, previously referred to as the "Medicare Advantage Disenrollment Period" is now called the "Open Enrollment Period".

5) Beginning in 2011, the Part D donut hole coverage gap began to decrease and will be completely eliminated in 2020. After that, a straight payment structure of 25% coinsurance by the enrollee and 75% payment by Medicare will be the standard. (In 2019, Part D enrollees receive a 75% discount on brand-name drugs and a 65% discount on generic drugs.) The full retail price of the drugs will still be applied to the amount enrollees are responsible for paying while in the donut hole, which will move them through the gap more quickly.

C - On July 30, 1965, the Social Security Amendments of 1965 Act was signed into law. This new law established the Medicare and Medicaid programs to deliver health care benefits to the elderly and the poor.

A - Medicare Part A was designed as a "pay ahead" program. Consequently, a hospital insurance (HI) trust fund was set up to be funded through American taxpayer contributions in the form of payroll deductions.

C - Centers for Medicare and Medicaid (CMS) refers to Medicare Advantage as "Medicare insurance." This term reflects the fact that these plans are intended to deliver, at a minimum, all of the benefits that Original Medicare delivers.

A - The primary purpose of Medicare Part D is to provide prescription drug benefits and coverage.