Medicare and Medicaid Insurance Programs - Assignment Example

Medicare Medicare is a medical insurance program whose primary purpose is to provide health care to citizens of the United s over the age of 65. In addition to the age requirement to be eligible for Medicare, the program also covers some individuals under 65 that are afflicted with specific ailments such as Lou Gehrig's disease. Functionally, the program has been administered as part of the Social Security program since 1965. Unlike Medicaid, which is a joint program administered by the states, Medicare is a federal program that is financed by Medicare payroll deduction taxes. In cases where the recipient has not worked enough to be eligible for full social security benefits, there may be a charge for their Medicare insurance through monthly premiums. Medicare covers many of the costs of health care for senior citizens, but its associated payments make it expensive to use for many of its beneficiaries. Medicare benefits will cover the cost of hospitalization, skilled nursing home care, and prescription drugs. However, these benefits are often subject to a significant co-pay or deductible and have limitations on their amount of benefits. For example, in-patient hospital care is covered for a period of 60 days, but is subject to a $1,024 deductible payment from the patient. An extended hospital stay, beyond 60 days, may require a co-payment of $256 per day. To deal with these costs, low income people may also be covered under Medicaid or carry supplemental Medicare insurance. Supplemental insurance, known as Medigap, is meant to cover the cost of these co-payments or deductibles and may even cover additional hospitalization days. Medicare also covers the cost of a limited stay in a skilled nursing facility. Eligible patients are covered for up to 20 days after which the patient is required to pay a co-payment of $128 per day for a period of up to 100 days. Since 2006, Medicare has also provided prescription drug coverage under part D of the Medicare program, known as Medicare Rx. This is a privately administered program offered by insurance companies to help defray the escalating costs of prescription drugs. There are numerous plans available that differ in their cost and benefits. Eligible members must choose a plan that will be of greatest benefit based on the types of prescription drugs that they are taking. In conclusion, Medicare is a federally financed and administered program that operates through the Social Security Administration. While it has been primarily aimed at helping people over 65, it does cover a few other specific ailments for people under 65. The benefits of Medicare cover many health issues of senior citizens such as hospitalization and nursing home care, but they are limited and have a co-pay or deductible that must be met by the patient. People over 65 that have a limited income are often covered under dual coverage of both Medicare and Medicaid. In addition, supplemental private insurance plans can be purchased to help meet the cost associated with using Medicare. A recent addition to the Medicare program, known as Medicare Rx, provides some coverage for prescription drugs under privately administered insurance programs. While Medicare is a much needed public health program, the escalating costs of health care in the US has continued to keep health care a substantial financial burden for senior citizens. Medicaid Medicaid is a program that is designed to meet the health care needs of our nation's poorest individuals. It is jointly financed by both the federal government and the states. Because the states provide a significant level of the funding for Medicaid, they are fundamental in determining the benefits and the eligibility requirements. Medicaid is designed to help those in poverty with special emphasis given to the needs of pregnant women and children. Like Medicare, Medicaid was established as part of the Social Security Administration in 1965. Since its humble beginnings, it has grown into a complex system of eligibility requirements and benefits. Medicaid is aimed at helping people in poverty obtain medical care with shifting requirements based on age and other demographics. The eligibility is set based on the relationship that the beneficiary has to the Federal Poverty Level (FPL). These requirements change over time based on state revenue and budgetary concerns. While children and pregnant women may be covered that make 200 percent of the FPL, single adults have to meet a much lower threshold of eligibility. In addition to age and income, eligibility may be determined by factors such as exiting foster care. In addition, the program can cover the cost of dental care, eyeglasses, and specific women's health issues. The overall goal of the Texas Medicaid program has been to cover as many people as possible, while saving scarce resources available for health care. It has attempted to replace the traditional method of emergency room visits that were covered by local and county hospitals or cost-shifting to insurance premiums. Wellness programs, and access to early treatments, have been instrumental in helping to contain the cost of health care in Texas. The Preferred Drug List also was responsible for considerable savings on the costs of prescription drugs. In many cases, Medicaid covers a broad range of expenses that include immunizations, x-rays, and hospital stays. Because it has grown to include a significant portion of the children in Texas, many health problems are prevented or treated at an earlier, and less expensive, stage. In conclusion, Texas Medicaid is a program that is a necessity for those living in poverty, and has been successful at helping to keep down health care costs in the state. More liberal eligibility requirements for children has made the program accessible for a significant number of this population. The end result is that healthier children make healthier adults, and saves money in the long-term. Texas budgetary constraints in recent years have seen the eligibility requirements shift in regards to the FPL. The legislature has been successful at working with unpredictable revenue streams by managing the eligibility requirements. The economic downturn of the early 2000s resulted in some cutbacks that have since been reinstated. The history of Medicaid in Texas has shown it to be a successful program that has lived up to its goals of covering as many people as possible, and especially children, while resulting in a net savings of health care dollars. Read More