Medicare Payment Systems Paper

Compare and contrast two Medicaid plans from different states. Discuss your opinions regarding each state being able to choose how they administer the Medicaid program for their state. Does this leave some Americans at a disadvantage? Explain.

Medicaid is a public health insurance that is federally funded for those who do not have private health insurance (Families USA, 2014). In the U.S. one out of every five adults and one out of every three children use Medicaid (Families USA, 2014).

Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).

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.

Government insurance programs designed to pay for the treatment of disease and medically diagnosed conditions (Peggy S. Stanfield, 2012).

Medicaid is defined as being a jointly funded state-federal health care program administered in Texas by the Health and Human Services Commission. Medicaid was established in 1967 and also stemmed from Patient Protection and Affordable Care Act P.L. 111-148 (Strategic Decision Support Team, 2010). Some of the goals and objectives within Medicaid are to make it less of a struggle for clients to get care, protects against out-of-pocket through the roof cost, and also to achieve cost savings for the state and federal government through the many improvements in coordination, as well as care (Eighty-First Texas Legislature, 1967).

In order to more fully delve into this issue, this literature review will be focusing on three main areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the Affordable Care Act. These areas of focus will include

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

Medicaid and Medicare are two programs that are very different but share the same instance of being federally run programs. Both Medicaid and Medicare were created in 1965 in response to the fact that older and lower income people could not buy private insurance. Medicaid is dispersed individually by each state in which is primary role is to cover low income people who do not have the financial means to purchase healthcare on their own. On the other hand Medicare is paid into by everyone that works a legal job where taxes are deducted. Medicare was created to address the issues of elderly; typically people 65 years or older; having extremely high healthcare bills but limited personal funding. These people will typically pay part of the cost

The purpose of this paper is to thoroughly examine the similarities and differences of Medicare and Medicaid managed care plans by comparing and contrasting its strengths, weaknesses, incentives, commitment to access, and risks to the consumer. Medicaid and Medicare are both health insurance programs financed and administered by government entities and are both equivalent in terms of the number of beneficiaries and total expenditures (McCarthy, Schafermeyer, & Plake, 2011). These healthcare programs differ in terms of how they are funded and governed and who they cover. Medicare is an important source of coverage for 65 or older adults, for people under 65 with disabilities, and for people of all ages with End-Stage Renal Disease in the United States. It provides health insurance protection and enables access to medical care for 54 million beneficiaries.

“Medicaid covers basic health care costs such as visits to the doctor and hospital stays, but can also cover things like the costs of eyeglasses… Medicare covers hospital and post-hospital facility charges, as well as home health care, doctor fees and lab costs, outpatient care, and prescription drugs” (Reuters). Medicaid covers simple costs, meanwhile Medicare pays for more expensive cost such as doctor bills. With Medicare there are four different parts: Part A, B, C, and D; however, each part has different coverages. Medicaid may charge patients small service fees and with Medicare there is a yearly deductible for all plans; with these different plans they copay lengthy time in the hospital which would be Part A, Part B covers 20 to 35% of medical bills, plus monthly premiums, and Part D has coverage gaps that will not cover total drug costs over $2,840, but will once total drug costs reach $4,550 (Reuters). Medicaid patients usually pay nothing, but a small co-payment is sometimes required. With Medicare, Medicaid will often pay for what Medicare will not pay for. For example, deductibles, premiums, and sometimes up to 20% off medical costs. For Medicare, payment charges may vary depending on what plan the patient has. With saying this, what services they cover and the cost are a big impact on which insurance the user would most

Medicaid is a federal and state program that helps with medical costs for some people who have a low income and limited resources. Medicaid is the largest source of funding for medical and health related issues in the United States. It provides medical care for nearly 60 million Americans (Medicaid History). Even though the program is joint between federal and state, the state decides how someone could be eligible for Medicaid.

Medicaid and Medicare are government-sponsored healthcare programs in the U.S. The programs differ in terms of how they are governed and funded, as well as in terms of who they cover. Medicare is an insurance program that primarily covers seniors ages 65 and older and disabled individuals who qualify for Social Security, while Medicaid is an assistance program that covers low- to no-income families and individuals. Some may be eligible for both Medicaid and Medicare, depending on their circumstances. Under the Affordable Care Act (a.k.a., "Obamacare"), 26 states and the District of Columbia have recently expanded Medicaid, thus enabling many more to enroll in the program.

Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.

The Medicaid program is jointly financed by the federal government and states. The federal government pays states for a specific proportion of program expenses, called the Federal Medical Assistance Percentage (FMAP). FMAP varies by state based upon criteria such as per capita income. There are no intermediary like Medicare’s HMO and PPO, so payments are made directly to providers. Medicaid covers health insurance up to 400% of Federal Poverty Line for those who are under age 65 and poor and/or disabled through income and excise taxes. Elderly over age 65 who are poor are dual eligible for Medicare and Medicaid. There is an employer-based insurance (EBI) and cost share is between employees and employers.