Why and when did Medicare start?

Health Line

10-07-2025

Medicare became law in 1965. It aimed to provide health coverage to United States citizens ages 65 and over. When first introduced, Medicare included only parts A and B. Additional parts have since expanded coverage.
Medicare celebrates its 60th anniversary in 2025. President Lyndon B. Johnson signed the program into law in 1965, and it began offering coverage in 1966.
In its first year, 19 million people enrolled in Medicare for their healthcare coverage. As of 2025, there are over 68 million enrollees in the program.
When Medicare first began, it included just Medicare Part A and Medicare Part B, and it covered only people ages 65 and over.
Over the years, additional parts — including Part C and Part D — have been added. Coverage has also expanded to include people under age 65 with certain disabilities and chronic conditions.
Overview of Medicare history
The following chart summarizes the history of Medicare. Read on to learn about these developments in more detail.
Years Developments
1912-1961 Campaigns for national healthcare led to recommendations for healthcare for those ages 65 and older.
1965 Medicare (parts A and B) and Medicaid became law.
1972 Medicare extended coverage to include people with disabilities on SSDI and those with ESRD.
1980s Medigap supplement plans standardized.
Hospice care added under Part A.
1990s Cost assistance programs, such as Extra Help and MSPs, created.
Medicare Part C (Medicare Advantage) launched.
2000s Cost assistance programs, such as Extra Help and MSPs, created.
Medicare Part C (Medicare Advantage) launched.
2010s: Free preventive care and screenings added.
Additional changes to Part C and D plan coverage rules.
2020s Campaigns for national healthcare led to recommendations for healthcare for those aged 65 and older.
What did people do for healthcare before Medicare?
Before Medicare, just over half of those ages 65 and older had hospital insurance, and many lacked coverage for surgeries or out-of-hospital doctor expenses. Private insurers often didn't cover older people who they considered high risk.
Federal or state programs existed but were limited in scope and eligibility. Even older adults with higher incomes faced significant financial challenges if they became seriously ill.
The idea of a national healthcare program originated more than 100 years ago, as far back as former President Teddy Roosevelt's 1912 presidential campaign.
A serious push for a program began in 1945 under former President Harry Truman. During his term, he called for a national healthcare plan and presented the idea to Congress. However, his proposals didn't make it through Congress at that time.
Which president started Medicare?
By the 1960s, the call for a national program was growing stronger. In 1961, former President John F. Kennedy created a task force recommending a program for people ages 65 and older.
On July 30, 1965, President Lyndon B. Johnson enacted the Medicare and Medicaid legislation.
When did Medicare A and B start?
When introduced in 1965, Medicare had only two parts: Medicare Part A and Medicare Part B. That's why you'll often see those two parts referred to as Original Medicare today.
Parts A and B looked pretty similar to the Original Medicare you may be familiar with, although the costs have changed over time. Just like today, Medicare Part A was hospital insurance, and Medicare Part B was medical insurance.
How much did Medicare cost in 1965?
Most people don't pay a premium for Part A, but need to pay one for Part B. In 1966, the monthly Part B premium was $3. By comparison, in 2025, it is $185.
When did Medicare start covering people with disabilities?
In 1972, former President Richard Nixon expanded Medicare coverage to include people with disabilities who received Social Security Disability Insurance. He also extended immediate coverage to people who had received a diagnosis of end stage renal disease (ESRD).
Later, in 2001, people with amyotrophic lateral sclerosis (ALS) also became eligible for Medicare before age 65. These expansions are still in effect today.
»Learn more: What to Know About Medicare Disability Coverage.
Hospice coverage
Medicare didn't initially cover hospice care for people with end stage diagnoses, but it added this coverage in 1982. Medicare Part A still offers hospice services today.
Cost-sharing
People used to pay the same amount for Medicare, regardless of income. Today, people from higher-income households might pay more, while people from lower-income households might pay less.
This change began in 1988 with the creation of programs to help enrollees from lower-income households pay for their Medicare premiums and other costs. Medicare added extra programs to help people pay for their Medicare coverage throughout the 1990s.
Some examples of these programs include the Extra Help program, which helps those from lower income households pay for their medications, and four different Medicare savings programs to help pay for premiums and other Medicare expenses.
In 2003, modifications to the Medicare Modernization Act led to the introduction of the Income-Related Monthly Adjustment Amount (IRMAA).
When did Medicare add Medicare Advantage plans?
The Balanced Budget Act of 1997 led to the introduction of Medicare Part C, with coverage beginning in 1999. Today, private insurance companies that contract with Medicare offer Medicare Part C plans, sometimes called Medicare Advantage.
Medicare Advantage plans work with a network of providers. Their coverage model is more similar to employer coverage than Original Medicare.
Today, these plans must offer at least the same coverage as Original Medicare, and they often include additional coverage for services that Medicare doesn't cover, like dental, vision, and prescription drug costs.
Part D
The Medicare Modernization Act, signed into law in 2003 by former President George W. Bush, also expanded Medicare and established Medicare Part D.
Part D is prescription drug coverage. Before Part D, Medicare didn't include this coverage. Part D officially took effect in 2006. Then, in 2010, former President Barack Obama signed the Affordable Care Act into law.
The law added Medicare coverage for preventive care and health screenings, making these services free for Medicare enrollees. It also changed some rules for private Medicare plans, such as Part C and Part D plans.
Beginning in 2023, all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) became freely available to Medicare enrollees.
The Inflation Reduction Act's (IRA) Medicare Part D provisions also introduced a new cap on annual spending for prescription drugs. In 2025, this amount is $2,000, and contributions from the Medicare Extra Help program also count toward this limit. In addition, Part D enrollees can now get low cost insulin for $35 or less per month.
As part of the IRA, the Centers for Medicare & Medicaid (CMS) negotiated lower prices for certain costly drugs, starting with 10 initial Part D drugs for 2026. By 2027 and 2028, CMS will select up to 15 more drugs for negotiation under Part D or Part B.
Medigap
Medigap, also known as Medicare supplement insurance, helps you pay the out-of-pocket costs of Original Medicare, like copays and deductibles.
Private insurance companies sell these plans. However, starting in 1980, the federal government began regulating them to ensure they meet certain standards.
Currently, 10 Medigap plans are available: A, B, C, D, F, G, K, L, M, and N. In 1980, Medicare standardized coverage under each of these plans. This means that no matter where you live or what company you purchase a plan from, you'll be guaranteed the same basic coverage from each plan. For example, Medigap Plan A in Boston offers the same basic coverage as Medigap Plan A in Seattle.
That said, keep in mind that Medigap Plans C and F are no longer available to new Medicare enrollees who became eligible on or after January 1, 2020. This change results from the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which prevents new Medigap policies from covering the Medicare Part B deductible. However, if you were eligible for Medicare before January 1, 2020, you might still be able to enroll in these plans.
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