Major Differences Between The Medicaid And Medicare Programs

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ion 1: Describe the major differences between the Medicaid and Medicare programs. Answer: Medicare and Medicaid both represent federal healthcare initiatives, still some major differences exist between those programs. The existing differences largely pertain to a number of factors such as overall mission & goals; authorities administering & implementing the programs; sources of program funding; eligible populations; range of services covered by the programs; and costs on the part of the program user (patient). Medicare represents a social insurance initiative with uniform, national rules. It is administered by federal officials and a number of insurance companies employed to manage particular tasks (e.g. part C & part D of the Medicare).…show more content…
Medicaid, in its turn, has a much more extensive range of benefits, with Federal Government mandating coverage for certain services which are deemed as medically necessary. Question 2: Describe the Medicare Part D “Donut Hole”. Give details. Answer: The “Donut Hole”, or coverage gap, represents one of the most controversial aspects of the Medicare Part D prescription drug plan and has been of concern to many Medicaid beneficiaries who have opted for the plan. A coverage gap, contained within the plan, obliges beneficiaries to pay for the full cost of their prescription drugs, despite beneficiaries continuing to pay their monthly plan contributions. To illustrate, in 2010, when Medicare patients ' out-of-pocket prescription drug expenses exceeded $2,840, they entered the “Donut Hole”. Coverage for medications resumed when expenditures totaled $4,550. These annual out-of-pocket expense amounts included yearly deductible, copayment, and coinsurance payments associated with the plan. The ACA of March 23, 2010 initiated several improvements to Medicare Part D, in order to reduce out-of-pocket expenses of beneficiaries when they reached the “Donut Hole”. In 2010, if beneficiary has expenditures in the coverage gap, he/she should be eligible for a $250 rebate from Medicare. In 2011, if beneficiary reaches the “Donut Hole”, he/she should be given a 50%
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