Drug Assistance Programs

Adults, 65 years old and older and people with disabilities are eligible for Medicare and Medicaid. Physician services and hospitalizations are covered by medicare. An additional supplemental program may be purchased to cover prescription drugs. Low income families and children may qualify for Medicaid and Children’s Health Insurance Program (CHIP). Medicaid has significantly lower copays and out of pocket expenses compared to private insurance. Unemployed individuals may qualify for Medicaid depending on the state.

Specific coverage and benefit details vary from state to state (Raffel, 224). This is intended to help people with high medical costs that are not old enough for Medicare.

The Medicare and Medicaid federal programs were put in place as a way to help the less fortunate. Individuals with severe disabilities or over the age of 65 qualify for Medicare. This program helps them with health coverage, so the disabled and elderly who have Medicare do not have to worry about their medical bills and not going to the hospital when they are sick. Medicaid is a similar program, however, it only applies to low income families who cannot provide for their children. Similar to Medicare, this program covers any health related problems and takes away the worry and troubles that come with hospital bills.

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

Medicaid, which is a separate federal funded insurance was intended to cover low-income, aged, blind, disabled individuals, parents, and their dependent children on welfare. However, the senior citizens are the population group most likely to be living in poverty, and only about half of these individuals have insurance coverage. The difference between 1965 and now, of course, is costs. Years ago spending more on health care in result covering more people were the whole point. The administration wants to broaden coverage, but cut spending.

Medicare part D is the prescription drug plan. Each plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different tiers on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost less than a drug in a higher tier. In some cases, if the drug is on a higher tier and the patient 's prescriber (the patient 's doctor or other health care provider who is legally allowed to write prescriptions) thinks the patient needs that drug instead of a comparable drug on a lower tier, the prescriber can ask the patients plan for an allowance to get a lower copayment. In the case of Mrs. Zwick Part D will cover the prescription drugs that she needs that are not covered by Medicare Part A and Part B unless those medications are on the unapproved list. What the patient will be responsible for paying

Finally, in a February 2012 proposed regulation, CMS proposed that state Medicaid agencies reimburse pharmacies for retail drugs based on actual acquisition cost. CMS recognized, however, that states may not be able to determine the actual price paid by a pharmacy for a drug billed to Medicaid, so it suggested that states survey pharmacies or rely on other data to calculate an average acquisition cost for drugs purchased and billed by retail community pharmacies. The article reviewed the association between benefit caps, prescription drug use, and the costs associated. It also detailed drug cost sharing, additional medical costs, and specific health outcomes. Using observational data, the studies analyzed the changes and did a cost comparison of outcomes at two points of time, before and after the pharmaceutical benefits changed. The article detailed the impact of pharmaceutical drugs was often difficult to analyze because some data analyzed utilization while others analyzed actual pharmaceutical spending. The data surrounding utilization compared as many as five factors such proportion

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

Medicare is one of the most widely acknowledged sources of health insurance coverage in the United States. It is often complemented by Medicaid, a similar health welfare program that includes children and the poor. Many Medicare beneficiaries are "dual eligibles" who use Medicaid to extend comprehensive inpatient and outpatient health care coverage, especially for prescription drugs, diagnostic and preventive care, and eyeglasses which fall outside of Medicare. Medicaid can also supplement Medicare deductibles, premiums, and up to 20% of uncovered charges (Goodman, 1991).

In this research paper it will identify how Medicaid came about and what Medicaid used for, the different between Medicare and Medicaid, the benefits and disadvantage in the use of Medicaid. Medicaid is a state administrated program that provides medical support for a broad range of people. Medicaid was established in 1965 through the Social Security Act, which was an act to provide for the general welfare by creating a system of senior citizen benefits as well as low income people not all but limited to and by enabling that many states to make more acceptable provision for aged people, blind, dependent and crippled children, maternal and child welfare, and public health. Medicaid program was one of many programs created to

It just seems crooked. Now whenever an elderly man or woman goes to a pharmacy to pick up prescriptions, it is going to be too expensive. Ordinarily, Pharmacies would try and reduce the price of the drugs. The store would try and see if there was a similar one like the drug and just have the person pay for that one or contact the insurance company and have the insurance cover the drug. Consequently, people just cannot pay for the drug by itself. Now, people pay both the insurance company and pharmacy just for one prescription drug that may not be worth the cost. For example, Tolterodine (Detrol, Detrol LA). Tolterodine, or Detrol, is a prescription drug used to help and control the

Medicaid is a medical assistance program for low-income Americans. It is funded partially by the federal government and partially by the state and local governments. The federal government requires that certain services be provided and sets specific eligibility requirements. Medicaid covers the following benefits required by the federal government; early and periodic screening, diagnosis, and treatment services, rural health clinic services, family planning services, SNF and home health services for persons over 21 years old, physicians’ services, laboratory and x-ray services, outpatient hospital care, and inpatient hospital care. Because Medicaid is also partially run by the state and local government individual states sometimes cover services

After the patient returns to a clean bill of health, Medicare coverage seizes (Hooyman & Kiyak, 2018). Ultimately, elderly people cannot rely on Medicare to pay for their long term care needs unless it follows an emergency medical condition. Even if it does, the coverage is only for a short period of time.

Those who have Medicaid do not have to pay a monthly premium for the long-term care portion of the benefit. The PACE program pays for a portion of the monthly PACE premium and Medicare pays for the rest, for those with Medicaid (Providers & Partners, N.d.). If an individual does not have Medicaid, then the person is responsible for the portion of the monthly premium Medicaid would pay for. Those who only have Medicare will be charged a monthly premium to cover the long-term care portion of the benefit and the Medicare Part-D prescription drugs. Further, those individuals who do not have Medicare or Medicaid can join a PACE program by paying privately. In addition, the PACE program has no deductibles and copayments, which is a great incentive for qualified individuals to participate in this model of care (Shi & Singh, 2012). Overall this program has a great cost savings compared to other forms of long term care delivery systems, while providing quality health

Drug and health plans are major resources to long-term care. Medicare does not cover most of long-term care services, but it may pay a portion depending on selected coverage. Medicaid may step in and help pay as well. “The Medicare Plan Finder tool provides one central point to view and compare all available drug and health plan