This year, Medicare Medicaid turned 54.
This means that a majority of New Yorkers cannot remember a time when these programs did not exist. Both programs were created through amendments to the Social Security Act. President Lyndon Johnson signed the legislation into law on July 30, 1965. In January of the following year, the president travelled to Independence, Mo. to present the first Medicare cards to former President Truman and First Lady Bess Truman. In 1945, just seven months into assuming the office, President Truman had proposed creating a national health insurance program.
The Medicare Program. When Medicare was created it consisted of only two Parts, Part A which is hospital insurance, and Part B, which covers medical needs. Together, these two parts are now referred to as Original Medicare.
The idea for having two parts appears to have derived from the major health insurance providers of the time, Blue Cross and Blue Shield. In 1965 they were two separate, but related companies. Blue Cross provided primarily coverage for hospital related charges, while Blue Shield focused on medical care coverage.
Outside of employer sponsored plans, this program was the only major model for organizing the reimbursement of care. During the 1990s the Medicare Advantage, or Part C, program was created.
At the time Medicare was introduced only about 60 percent of older people had any type of medical insurance coverage.Medicare was designed to provide coverage to everyone over the age of 65. Today to qualify for Medicare you must be aged 65 or older, be younger than 65 with a qualifying disability or have a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Greig’s disease). In addition, to qualify for Medicare, you must be a legal resident and live in the U.S. for at least five years, including the five years just before applying for Medicare.
The Medicaid Program. The legislation that created Medicare also created Medicaid, the insurance program that provides health coverage to eligible low-income adults, children, pregnant women and people with disabilities. Medicaid is a federal program that is administered by the states. New York is one of 26 states that requires counties to contribute to the cost of Medicaid. According to Medicare.gov, in April of this year, 67.5 million people in the U.S. were covered by Medicaid.
One final note on Medicaid — According to the Kaiser Family Foundation, in 2015 Medicaid was the primary payer for long-term care including cost of caring for 6 out of every 10 nursing home residents.
The Children’s Health Insurance Program. In 1997, under President Bill Clinton, Congress passed the Children’s Health Insurance Program (CHIP) to provide health insurance and preventive care to approximately 1 in 7 uninsured American children. The program was designed to cover the children of lower-income working families who earned too much to qualify for Medicaid. CHIP plans are now available in all 50 states, the District of Columbia and the U.S. territories.
These three programs work together to provide support for older adults. According to the state Department of Health, approximately 1 out of 4 Medicare beneficiaries are classified as being a dual eligible. That is, they receive benefits from both Medicare and Medicaid benefits.
While this seems to be an obvious connection, the connection between older adults and CHIP is less clear. The connection is found in the increasing number of older people who are raising grandchildren. According to Grandfamilies.org, in 2018, more than 52,000 households in New York were headed by someone aged 60 or over was fully responsible for caring for one or more of their grandchildren. For these New Yorkers, the CHIP program is a life saver.
The Medicare Part D Prescription Drug Benefit. Prescription drug coverage under Medicare was first Proposed under President Bill Clinton in 1999. Four years later, Medicare Part D (the Medicare Prescription Drug Improvement and Modernization Act of 2003 or MMA) was passed by Congress and signed into law by President George Bush.
Part D represented the biggest change to the Medicare program in 38 years. Part D has a number of complexities, including a wide range of choices of “stand-alone drug plans,” wide variation in costs to beneficiaries (premiums, deductibles, coinsurance), low-income subsidies and middle-income help and plan formularies.
The Affordable Care Act. The 2010 Affordable Care Act (ACA) created the Health Insurance Marketplace, a single place where consumers can apply for and enroll in private health insurance plans. It also funded new ways to design and test how to more efficiently pay for and deliver health care. Medicare and Medicaid have also been better coordinated to make sure that dual eligibles can get quality services. In addition, it is through the ACA that the “donut hole” in the Part D program is being eliminated.
Who do I contact in Oneida County for help? The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices provide their services at no cost to Medicare beneficiaries.HIICAP offices are found at the following locations:
Copper City Community Connection (formally the Ava Dorfman Senior Citizens Civic Center), 305 E. Locust St., with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m. While consumers are seen on a “first come, first served” basis, you may call the center at 315-337-1648 to see if there are long wait times. North Utica Senior Citizens Community Center, 50 Riverside Drive, Utica with hours of operation on Monday, Wednesday and Friday from 10 a.m. to 2 p.m. Consumers are counseled on a “first come, first served” basis. However, if you want to call ahead to see how busy the office is you may call the Center’s HIICAP program at 315-724-8680.
HIICAP services are provided by Oneida County Office for Aging and Continuing Care/NY Connects. Anyone with questions about HIICAP, including issues with your Medicare Advantage Plan, should call the program directly at 315-798-5456 and press 4 in the choice list. It will direct you to someone who can assist you.
Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY.He writes a monthly column on HIICAP related issues for the OFA.Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.