Watch the following video in preparation for this assignment: Grimes, D. (2011). What is the difference between Medicare and Medicaid?. Retrieved from https://www.youtube.com/watch?v=0ZVRcQyrEIw Use what you learned from the video, the module’s required readings, and your own research to answer the following questions in your paper. Length: Submit a 2-page paper.
Medicare and Medicaid are two health insurance programs in the United States that provide coverage for different populations and have distinct funding sources. This paper will provide an analysis of the differences between Medicare and Medicaid, drawing from the designated video, required readings from the module, and additional research.
Medicare is a federal health insurance program that primarily serves individuals aged 65 and older, as well as younger people with disabilities and individuals with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). It was established in 1965 under Title XVIII of the Social Security Act and is administered by the Centers for Medicare and Medicaid Services (CMS). Funding for Medicare comes from various sources, including payroll taxes, premiums paid by beneficiaries, and general revenues from the federal government (Social Security Administration, 2021).
There are four different parts of Medicare: Part A, Part B, Part C, and Part D. Part A covers inpatient hospital services, skilled nursing facility care, and some home health and hospice care. This part is generally funded through payroll taxes paid by both employees and employers during a person’s working years. Part B covers outpatient medical services like doctor visits, diagnostic tests, and preventive services. Beneficiaries enrolled in Part B pay a monthly premium, and the program is also financed by general revenues. Part C, also known as Medicare Advantage, allows beneficiaries to receive their Medicare coverage through private insurance plans. These plans must provide at least the same level of coverage as original Medicare, and they often include additional benefits like prescription drug coverage. Part D, which was implemented in 2006, covers prescription drugs and is administered by private insurance companies. Beneficiaries enrolled in Part D pay monthly premiums, and the program is partly funded by both general revenues and beneficiary premiums (Centers for Medicare and Medicaid Services, 2021).
In contrast, Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. It was established in 1965 under Title XIX of the Social Security Act and is also administered by the CMS. Unlike Medicare, Medicaid eligibility and benefits vary from state to state, although there are federal guidelines that states must follow. The program is funded by both the federal government and individual state governments. The federal government matches a percentage of each state’s Medicaid spending, with a higher matching rate for states with lower per capita income. There is no premium for Medicaid, but some states may require small copayments for certain services (Centers for Medicare and Medicaid Services, 2021).
Medicaid primarily serves low-income children and parents, pregnant women, elderly adults, and individuals with disabilities. Each state sets its own eligibility criteria within federal guidelines, and it is important to note that not all low-income individuals qualify for Medicaid. Medicaid provides a comprehensive range of services, including doctor visits, hospital care, long-term care, and prescription drugs. States also have the option to provide additional services beyond the minimum requirements set by federal law (Centers for Medicare and Medicaid Services, 2021).
It is worth mentioning that there are some overlaps between Medicare and Medicaid. Certain individuals may be eligible for both programs, and in such cases, Medicare is the primary payer while Medicaid can serve as a secondary payer to cover costs that Medicare does not. This is known as “dual eligibility” and is often applicable to low-income elderly individuals or individuals with disabilities who meet the criteria for both programs.
In conclusion, Medicare and Medicaid are distinct health insurance programs in the United States. Medicare primarily serves the elderly, individuals with disabilities, and those with ESRD or ALS. It is federally funded through various sources, and beneficiaries may enroll in different parts of the program to receive specific types of coverage. Medicaid, on the other hand, provides coverage primarily to low-income individuals and families, with eligibility and benefits varying by state. Both programs play crucial roles in ensuring access to healthcare for different populations, but they have unique characteristics in terms of funding, eligibility, and services covered.