Ad for fredericksburg medicare specialist Jim Gilbert


  • In 1965, under the Johnson administration, Congress funded Medicare for the expressed purpose of providing a health insurance plan for senior citizens who qualified for retirement. The law provided 80% coverage for the Part “A” hospitalization and Part “B” medical expenses, leaving a 20% responsibility for the patient. The required qualification was that the employee work 40 Quarters (10 years) and pay FICA tax. The social security system collected and held the FICA funds in a separate account for disbursement to the Medicare department, which in turn would pay bills to hospitals or medical facilities as requested.
  • In 1966, Congress allowed insurance companies to sell Medi-Gap Supplemental insurance policies to cover the 20% shortfall in medical bills. The administration of Medicare benefits was still held by the Department of Health and Human Services.
  • In 1972, Congress allowed Medicare to cover disabled citizens.
  • In 1980, under the Carter administration, Congress funded the Omnibus Reconciliation Act that brought about the Part “D” prescription drug act that greatly reduced the cost of medication for seniors.
  • In 2003, under the Bush administration, Congress funded the Medicare Modernization Act that created Medicare Part “C” called the Advantage Plan.
  • Some Key elements of Part “C”
  1. Fraud, waste & abuse continued to grow out of control.
  2. Growing population needing coverage– 44 million baby boomers turning age 65 over the approaching 15 years.
  3. 77 million existing Medicare members could bankrupt the system.
  4. The cost of administrating Medicare would continue to grow out of control.
  • In 2003, the administration of Medicare changed hands from the government to the insurance companies.
  • Resulting Cost Reduction
  1. 01/01/2006 Medi-Gap supplement with prescription drug plan, the best (most expensive) plan premium was $475 per month.
  2. 01/01/2024, the premium price dropped to $230 per month, due to increased competition.
  3. 01/01/2006, the Medicare Advantage HMO Plan had a premium of $0.00 per month, with a primary care physician co-pay of $10 per visit and a physician specialist co-pay of $35 per visit.
  4. 01/01/2024, the same HMO still has a $0 per month premium with a PCP co-pay of $0 per visit and a PS co-pay of $0 per visit. The HMO has included a $0 premium prescription drug plan, with extra benefits for Vision, Dental, Hearing, Silver Sneakers and more.
  5. 2003 to 2024 the waste prevention measures reduced costs by an estimated 75%.
  6. Everyone who has Medicare (including Tricare) pays the same Part “B” premium except disabled or low-income citizens.
  7. 2023 some Medicare Advantage plans started offering a Plan ‘B” rebate up to $150.00 per month.

James Gilbert (717)-779-5164 jbg14omgt@gmail.com  Va Lic 937614

Not associated with any Gove