Medicare and Medicaid - Essay Example

Medicare and Medicaid Government programs such as Medicare and Medicaid was created by President Lyndon B. Johnson on July 30, 1965. Medicare and Medicaid cater medical and health-related concerns among people of the United States. Both of these health programs serve millions of U.S. citizens. Medicaid is a social protection program for families with low income and few resources. A state must establish eligibility standards, scope and rate of the service, as well as own Medicaid program. However, funds allotted for Medicaid must meet federal requirements to include services in hospital care, prenatal care, vaccination, health provider services, rural health services, etc.

A state sets its own eligibility standards. Qualifying for eligibility depends upon age, pregnancy and disability status, citizenship, and other assets. The state includes individuals who receive federally assisted income-maintenance payments and who do not receive cash payments. Medicaid focuses on the group who needs the outmost assistance due to financial instability. Federal poverty line level (FDL) determines the families who will receive the Medicaid program. However, not all the poor benefit from or receive the Medicaid program.

Among poor groups in America, about 60% are not covered by the Medicaid program. Under the Medicaid, the state makes an agreement with the Health Maintenance Organizations (HMOs) to pay the health care providers and reimbursed Medicaid expenditures from the Federal Government. All Medicaid beneficiaries are exempted from copayments for emergency services and family planning services and exclude pregnant women, children under age 18, and hospital or nursing home patients. On the other hand, Medicare is a social, health insurance program intended for the elderly and disabled Americans.

Medicare has four parts. Part A and B deal with hospital insurance while part C and D deal with prescription drugs. Part A (Hospital Insurance) covers hospital stays, home health care, walkers, and wheelchair. No monthly premiums are used in expense. Part B (Supplementary Medical Insurance) covers physician and outpatient visits, as well as home health care cost. Unlike Part A, Part B requires a premium. Part C (Medicare + Choice) allows the users to choose from available health insurances and make some modifications regarding preventive health care.

Part D covers insurance with regards to prescription drugs and requires a premium. Medicare users must be 65 years old, disabled, has end stage renal disease, a U.S. citizen, and a SSS contributor for 10 years. Health services not covered by Medicaid or Medicare fall under MediGap. However, MediGap does not cover expenses in prescription drugs. Federal Insurance Contributions Act (FICA), Self-Employment Contributions Act, premiums, deductibles, coinsurance, and copays fund Medicare. On April 26, 2011, The Centers for Medicare & Medicaid Services (CMS) proposed policy changes in terms of payment for inpatient rehabilitation facilities.

Increase in Inpatient Rehabilitation Facilities (IRFs) by 1.8% is presented to give quality care. The increase in IRF, specifically, will improve patient safety, prevent hospital-acquired diseases and provide well-coordinated person-and-family-centered care. IRF is in line with the goals of the Partnership for Patients in making health care available to all Americans. Medicare and Medicare were deemed important by Americans. The government, together with health experts, raised the topic on IRF because IRF plays a vital role in critical care settings.