Original Medicare is medical insurance for people over the age of sixty-five, and people under sixty-five with a long-term disability, or those who have certain disabilities like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig’s disease. Once you’re eligible, there’s no need to medically “qualify” for Medicare—you get it regardless of your current health. There are no health questions you need to answer to get Medicare. Once you have it, you cannot get kicked off of it for any medical condition or health-related reason. While there are certain limitations to care, and monthly premiums may differ from individual to individual, it does not “run out.”
There are four parts of Medicare. Medicare Part A and Medicare Part B were the original choices rolled out in the 1960s. Thus, Original Medicare refers to Medicare Part A and Part B; Part C and Part D were added later. It’s a bit of an alphabet soup, but I’ll briefly explain what each letter does (and doesn’t) mean below.
Medicare was established on July 30, 1965, by President Lyndon Johnson, and—fun fact—the first Medicare recipients were President Harry Truman and his wife, Bess.
When the George W. Bush administration oversaw the passage of the 2003 Medicare Modernization Act, they made two hugely positive changes to Medicare that influence what you can buy, what it costs, and what it covers to this very day.
First of all, the Medicare Modernization Act introduced prescription drug coverage, also called Medicare Part D. From 1965 until the act was implemented in the 2005–2006 timeframe, people on Medicare had to pay full price for prescription drugs at the pharmacy out of their own pockets. Yes, it covered drugs needed in a hospital setting for, say, anesthesiology to put you under for surgery, and covered some other drugs under Medicare Part B. But if you had a statin for your cholesterol that you filled at the pharmacy, prior to the passage of the new Act, you paid for that 100% out of your pocket.
The second thing this Act did was increase payments and provided incentives for insurance companies to offer things called “Medicare Advantage plans,” also known as Medicare Part C. If you’re on Medicare and are reading this, you’ve probably heard all about these, and one-third of you have one for your Medicare insurance coverage. These plans were also introduced to the masses in the 2005–2006 timeframe, and the insurance companies who jumped at the chance to offer these products earlier than others were Humana and UnitedHealthcare, as well as some other smaller or start-up companies who have since been largely swallowed up by bigger insurance companies.
Until the Medicare Modernization Act was passed and insurance companies began rolling out Medicare Part D Prescription Drug Plans and Medicare Advantage plans to the masses, you basically had two choices to make when you turned sixty-five. One choice was “free” in that, besides having a small monthly premium for Medicare Part B deducted from your Social Security check, you just “got” Medicare Parts A and B. The only other choice was to buy “extra” insurance. That “extra” insurance was a Medicare Supplement plan. You simply paid for prescription drugs out of your pocket.
Fast forward to today; the Medicare insurance field has become vastly more complex for you, the Medicare consumer. Quite frankly, it’s become vastly more complex for Medicare insurance companies and Medicare insurance agents, too. Decades ago, you only had one choice to make when you turned sixty-five—whether or not to buy a Medicare Supplement Plan. Today, you essentially have three:
- stay on Original Medicare and only buy a Medicare Part D Prescription Drug Plan or,
- stay on Original Medicare and buy a Medicare Part D Prescription Drug Plan and a Medicare Supplement Plan or,
- buy a Medicare Advantage plan that includes Medicare Part D benefits.
Today, any of those three options lead you down a dizzying array of rabbit holes with potentially hundreds of additional choices. As a consumer, you now have thousands of combinations and choices on your Medicare menu.
That’s where Chicagoland Medicare can help!