Legislation creating Medicare was passed in 1965 and enrollment began one year later, in 1966.  Nobody knew if Medicare would be a success or failure. Would seniors enroll in the program? Would doctors and hospitals participate? Would the country be destroyed by this socialist program?

Five thousand people were hired by the government to go door-to-door to enroll people, 65 and older, into the Medicare health insurance program. The Part B premium was $3 per month, and many seniors said they could not afford to pay that much. (The monthly premium is $104.90 today.)

The American Medical Association (AMA) ran ads condemning Medicare, saying it would lead to socialized medicine. Ronald Regan was hired by the AMA to speak out against the legislation, and he predicted “a thousand years of darkness” if Medicare was implemented.  Here is more of what Ronald Reagan had to say about Medicare:

One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. . . . We are against forcing all citizens, regardless of need, into a compulsory government program….the consequences for “our children” would be dire: “we will sentence them to take the last step into a thousand years of darkness.”

The Washington Post has an interesting article that looks back on the startup of Medicare in 1966, titled, “When Medicare launched, nobody had any clue whether it would work”.

The doom and gloom predictions over Medicare in 1966 seem very similar to the anti-Obamacare talk today.  As it turned out, older Americans appreciate Medicare and know how important it is to their health – and to their financial well-being.

Only time will tell if the more than 30 million Americans without health insurance will sign up for coverage in 2014.

Will there be too many patients for the the number of doctors?  In 1966, anti-Medicare voices said hospitals would be overwhelmed with old people wanting care. That didn’t happen.  Ronald Reagan said we would be plunged into a thousand years of darkeness. That didn’t happen either.

Preventive screenings are covered by Medicare at no cost to the patient, but sometimes there will be a bill to pay.  A colonoscopy is the example I use with my clients to explain how “free” tests and procedures sometimes turn out not to be free.

Last month, a client called me to complain about a bill she received for her colonoscopy. “Should I pay this bill?” she asked. “I thought this test was supposed to be free!”

My quick reply to her question was, “Yes, you must pay that bill”. Then I said, “They found polyps and removed them, didn’t they?”  She wondered how I could know the results of her colonoscopy, so I told her how a free screening can turn into a billable procedure.

A preventive screening colonoscopy is “free” to the patient – but when the doctor finds polyps and removes them, that preventive screening procedure turns into “outpatient surgery”. This client told me her bill was $250, and sure enough, her Medicare Advantage plan has a $250 co-pay for outpatient surgery. This is how I deduced that polyps had been found and removed during her colonoscopy.

Here is the list of preventive screenings covered by Medicare at no cost to the patient. I’ve highlighted the most common ones.

Abdominal Aortic Aneurysm Screening

Alcohol Misuse Screening and Counseling

Bone Mass Measurement (Bone Density Test)

Cardiovascular Disease (Behavorial Therapy)

Cardiovascular Screenings (cholesterol, lipids, triglycerides)

Colorectal Cancer Screenings

Depression Screening

Diabetes Screening

Flu Shot

Glaucoma Test

HIV Screening

Mammogram (screening for breast cancer)

Obesity Screening and Counseling

Pap Test and Pelvic Exam (includes a breast exam)

Prostate Cancer Screenings

When people first begin their Medicare coverage, they get a free “Welcome to Medicare” visit with a primary care doctor.  This preventive screening visit might not be important to someone who has had health insurance and has seen their primary care physician every year or two. But I meet quite a few people who have not had health insurance and have not been to a doctor in many years.

This is from Medicare.gov:

“Welcome to Medicare” preventive visit: You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed. It also includes:

• Height, weight, and blood pressure measurements
• A calculation of your body mass index
• A simple vision test
• A review of your potential risk for depression and your level of safety
• An offer to talk with you about creating advance directives
• A written plan letting you know which screenings, shots, and other preventive services you need

When will you pay?

While the Welcome to Medicare visit is free, with no co-pay, no co-insurance, or deductible, if the conversation goes beyond the services listed above, there will be a bill.

An example:  Mary has not been to a doctor in years. She has just gotten her Medicare and she visits her doctor for her “Welcome to Medicare” screening. The doctor goes through his list of questions for Mary and then asks her if there is anything else she’d like to discuss.

Mary says she is concerned about her sore shoulder which she can hardly move without lots of pain. When the doctor checks out the shoulder and moves her arm up and down to see what causes her pain….that has gone beyond the wellness visit.  Now Mary will be getting a bill.

A doctor office visit comes under Medicare Part B, and Part B has an annual deductible of $147 (in 2013). If Mary has only Medicare (and no supplement), she will get a bill, probably for $147.  It all depends on the billing code the doctor uses and what the charge for that code is. It also depends on what else the doctor might address beyond the “Welcome to Medicare” list above.  If the total bill is more than $147, the patient will be responsible for 20% of the rest of the bill. That shouldn’t be to much.

If Mary has a Medicare supplement Plan N, she will have to pay the Part B deductible ($147).  If Mary has a Medicare supplement Plan F, she will owe nothing on the bill because her Plan F will pay the $147 deductible and any co-insurance.

If Mary is enrolled in a Medicare Advantage plan, she will be charged the doctor visit co-pay because the doctor went beyond the “Welcome to Medicare” list of services. Advantage plan co-pays for Primary Care visits range from $0 to $25, depending on the plan.

For a quick overview of your Medicare choices, see this video:  Intro to your Medicare Choices