Medicare and Medicaid Overview

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.

According to Barton (2010) Long-term Care “emphasized continuous care over a period of at least 90 days for a range of acute and chronic conditions. Regardless of the length of time (i.e., from weeks to years), LTC is an array of services provided in a range of settings to people who have lost some capacity for independence because of an injury, a chronic illness, or a condition” (pg. 349). This is the description of someone who may have been in a debilitating car accident, an elderly person with Alzheimer’s and dementia, a person diagnosed with chronic mental illness, and individuals who are developmentally delayed or “disabled.” People who are placed in these type of long-term care facilities are usually screened using two different

As we become older, issues with our health begin to take affect and finding ways to fund for that care is becoming even more difficult. In the article “Some Elders Must Take Drastic Measures to Obtain Long-term Care”, national magazine journalist Mary A. Fischer (2011) states that many Americans must face demeaning and disempowering choices in order to qualify for Medicaid or Medicare—federal funded health insurance programs— such as refusing to pay for a spouses institutionalization, divorce, and spending down assets. The author argues that these choices leave the healthy spouse with decreased funds to plan for their own retirement expense (Fisher, 2011). Working in the health care field for 4 years, along with my family’s own personal experiences I can relate to this article, since I have seen a variety of ways that federal funded health insurances have been unable to meet the expectations and demands of its beneficiaries.

Medicare enrollees in Utah have saved about $78 million on prescription drugs due to the ACA. Coverage for both brand name and generic drugs will continue to increase until the coverage gap is closed. The ACA also allows Medicare beneficiaries to seek preventive services without worrying about cost, due to the lack of deductibles and copays. This aids in detecting and treating health problems early on. In Utah in 2014, 220,972 individuals with Medicare used free preventive services. In addition to that, fraud is at a minimum due to tougher screening procedures, penalties, and technology developments.

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

The Medicare and Medicaid programs were signed into law on July 30, 1965 by President Lyndon Johnson ("Centers for Medicare," 2012). Before this decision was even taken into consideration, many other healthcare reforms had previously been introduced by earlier presidents, but failed to pass the Senate. Healthcare issues have always been on board for the United States, but during this time the elderly and the poor were desperately screaming for help. The government had no choice but to come up with a solution to their healthcare needs; these two

Suitable health care would not be possible for the elderly population in America without the assistance of Medicare Part A. Medicare did not come about easily. Currently Medicare spending is more than what is being collected, questioning future solvency. There are many challenges with sustaining Medicare into the future. Medicare’s past struggles, present outcomes, and future challenges confirm that a national health plan is ever evolving to meet the needs of the current population and spending inflation.

Medicare is national government run program that was developed in 1965. Medicare provides health insurance to Americans aged 65 and older who have worked and contributed to the program throughout their whole life by utilizing around 30 private insurance companies. The program also assists in providing benefits for younger people with disabilities. As well as offering Medicare in the United States a program called Medicaid is also available. Which is also a government run program, Medicaid is a state run program that provides hospital and medical coverage for people with low income (Medicare, 2015). With Medicaid being a state run program that allows each state to have different rules and regulations for who is and isn’t eligible as well as if they move across state lines. The programs listed above have helped many Americans over 65 and have a low income to be able to afford healthcare and receive the proper services for their healthcare concerns and issues. With any program and especially a government program there are going to be people who use and abuse the process which leads to Medicare and Medicaid fraud. There are many forms of fraud in Medicare and Medicaid such as billing for equipment or services that weren’t needed, falsifying health issues, dispensing generic prescriptions but billing for name brand. With there being so many types of fraud and investigations happening more and more due to the fraud that is occurring, people are finding more and more ways 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

This paper will discuss the early years and failed efforts that transformed the Medicaid program into what is seen today. A comparison between Medicaid and Medicare will be brief but is necessary because there are significant and critical differences between these government-funded insurance options. The substantial growth of Medicaid expenditures and beneficiaries are important and these trends will be looked at in detail. There have been provisions related to the unanticipated expansion of this program which will be reviewed. Attempts to expand Medicaid eligibility further need to be addressed (example: Patient Protection and Affordable Care Act). Stigmas that are associated with receiving Medicaid will be reviewed. I will share my

One of this health care’s programs objective is to limit the number of uninsured (Shi & Singh, 2015). This controversial healthcare plan incorporates a privately funded insurance which is paid for through employment and solely by the patient and a publicly funded insurance by the government. Medicare is provided for senior citizens 65 and older, and Medicaid is provided for low income citizens. The federal government and state government both partake in the funding of Medicaid. Although insurance is provided to the low income through Medicaid, the United States continues to suffer from cost escalation spending 17.1 percent of GDP on healthcare in 2013, a 50 percent more than the second nation (Commonwealth, n.d.) The high cost and limited coverage continues to spark up the conversation for a

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

The idea of a national healthcare plan was first introduced in 1945 by President Harry Truman. Although President Truman was unsuccessful in creating a government administered healthcare program, he was successful in bringing attention to the issue of healthcare in the United States. In 1965 the United States’ Congress passed a bill approving the Medicare program. This program was designed to allow the country to provide elderly citizens access to affordable medical care. This bill was signed into law a few days later by the 36th president, Lyndon B. Johnson. After signing this bill President Johnson stated, “We marvel not simply at the passage of this bill, but that it took so many years to pass it.”(Forty Years of Medicare 1). Finally, twenty years after President Truman first proposed a

Due to the upcoming presidential election, the two major political parties, and their candidates, have been focusing on the primary problems that the nation will face. Chief among those problems is the future of Medicare, the national health-insurance plan. Medicare was enacted in 1965, under the administration of Lyndon B. Johnson, in order to provide health insurance for retired citizens and the disabled (Ryan). The Medicare program covers most people aged 65 or older, as well as handicapped people who enroll in the program, and consists of two health plans: a hospital insurance plan (part A) and a medical insurance plan (part B) (Marmor 22). Before Medicare, many Americans didn't have health

Both Medicare and Medicaid are managed by the Centers for Medicare and Medicaid Services (CMS), which is a division of the U.S. Department of Health and Human Services. Medicare was created in 1965 when people of over 65 found it impossible to get private health insurance coverage. Medicare is a Federal health insurance program that pays for hospital and medical care for elderly and certain individual with disabilities. The program consists of two main parts for hospital and medical insurance (Part A and Part B), and two additional parts the provide flexibility and prescription drugs (Part C and Part D). Medicaid is a health and medical service program for certain individuals and families with low incomes and few resources. Primary oversight is handle at the federal level, but each state establishes its own standards, determines the type, amount, duration and scope of services, sets the rate of payment for services, and administers its own Medicaid program. Reimbursement to providers are through a fee-for-service model or through various prepaid arrangements, such as a HMO plan. ACOs create incentives for health care providers to work together to treat an individual patient across healthcare settings, which includes doctor’s offices, hospitals, and long-term care facilities. There are several factors, in my opinion, for ACOs to be successful. Buy-in from all involved with physician leadership, hiring the right professionals who are interested in having the mindset