Medicare and Medicaid Essay

Medicaid and Medicare are two different government programs. Both programs were created in 1965 to help older and low-income families be able to buy their own private health insurance. These programs were part of President Lyndon Johnson’s “Great Society” plan, a commitment to helping meet the needs of individual health care. They are social insurance programs, which allow the financial load of patient’s illnesses to be shared by other healthy, sick, wealthy, and lower income individuals and families. Medicaid insurance covers approximately 60 million Americans, according to their income.

Medicaid is larger than any other single private health insurance program. The criteria for participating would include those who are unable to work due to disabilities, anyone who receives Aid to Families with Dependent Children (AFDC), as well as single, pregnant women who fall below the Federal Poverty Level (FPL). In 2011, the FPL for a family of four was set at $22,350. This amount is updated yearly. Medicaid also helps those who are part of the Supplemental Social Security Income (SSI) program (Mann, 2012).

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Funding for Medicaid comes from the government as well as each state’s department of SSI. They are also responsible for administering funds.

In the other hand, Medicare is a federal government program that offers individual health care insurance to those who are 65 or older, and/or have a disability, no matter what their income level. Taxes that are deducted from one’s payroll helps pay for the Medicare program. Medicare is intended to benefit seniors, younger people with specific disabilities, and people with end stage renal disease. The Medicare program has four parts; Parts A, B, C, and D. The social security department pays for a portion of Part A. Part A helps pay for inpatient hospital care, skilled nursing care, hospice care and other services. Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors’ fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A. Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee.

You must have both Parts A and B to enroll in Part C. Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan. The history of Medicare began decades ago in 1945, when President Harry Truman had a vision that Americans should have affordable health care. He fought for the idea, but it was an idea before its time. Medicare is a health care insurance program, which put simply is overseen by the United State Federal Government. Today the chain of acronyms, which oversee Medicare, leads to Health and Human Services, HHS, and the Center for Medicaid and Medicare Services, CMS. In 1945 Harry Truman was called a socialist. Today the same label has been pinned on President Obama. Perhaps the real question might be how does a country provide all of its citizens and residents health care without some level of socialism? In 1965 when Lyndon Johnson was President, he signed into law Medicare and Medicaid, which is a program that offers assistance to the indigent population.

Ironically, the first person to enroll in Medicare was the former President Harry Truman. Over the following years, from 1965 to present, the provisions of Medicare have expanded. In 1972 benefits for speech therapy, physical therapy and chiropractic visits were added. This was also the year that payments to health maintenance organizations were added to the potential benefits. It was 1982 when hospice benefits were added on a temporary basis. Hospice became a permanent benefit in 1984. The next big change came in 1997 when Medicare added a Part C, Medicare Plus Choice which translates as health insurance programs offered by private companies but approved by Medicare. When Medicare first went into effect the monthly premium for Part B, medical insurance, was three dollars. As it stands today in year 2010, Part A, hospital premium, is $254 to $461 per month. Part B, the medical insurance portion, is $96.40 for those individuals whose income does not exceed a certain amount. There are also multiple co-pays and carve-outs, which further increase the cost to the patient.

The ceiling restrictions put on various costs, such as the daily allotment for hospital stays and skilled nursing facilities, often do not fully cover the patient’s expenses. Today, Medicare recipients must carefully review their Medicare benefits and compare and contrast them with their private insurance. Some providers do not take new Medicare patients. There are benefits that are the responsibility of the Federal government, and others that belong to the State government. It is a challenge for elderly patients to even understand their benefits. Medicaid and Medicare both play important parts in paying for health care for seniors. They are, however, very different. There are many details, but here are three big differences. Variability: First, Medicare is more or less the same in every state, but Medicaid rules vary widely state by state. You must know which state a senior is living in, before you can decide whether they are eligible for Medicaid, for example.

Eligibility: The second difference is eligibility. All seniors who paid into the Social Security system are eligible for Medicare. By contrast, Medicaid is a welfare program, so that a senior must have low income and limited assets in order to qualify. Those income and resource limits vary by state. Usually seniors apply for Medicaid through a local Medicaid office or begin the application process with the help of a nursing home or other facility’s staff member. Coverage: The third difference is coverage. Medicare currently pays for 80% of the cost of doctors and hospitals. Congress is now considering whether to add coverage for prescriptions. Medicare will pay for part of nursing home costs during the first 100 days after a hospital stay, but not otherwise. By contrast, Medicaid provides the majority of funding of nursing home residents in the nation. Often a senior enters a nursing home with certain assets and has to pay for the cost of care until they run out of money.

Then Medicaid steps in and pays for the remaining part of the nursing home stay. If the senior is married, the spouse not living in the nursing home gets to keep a modest amount of income and resources in order not to be impoverished. Currently, all states must allow a spouse to keep at least $1,383 of the monthly family income and at least $16,824 of non-exempt resources. Certain resources are exempt, of which the most important is their principal residence, if they own it. It is possible to transfer certain assets to other family members, but the rules are strict and vary by state. You may also be able to obtain Medicaid-funded services for the senior in his/her home. Eligibility requirements vary by state. The varying structures of Medicaid and Medicare health care plans have resulted to conflicting incentives with respect to dual eligibility in beneficiaries without coordinated care. The main interest of both health care plans is to cut medical costs and none of the plans has an incentive that accounts for the quality of health care services offered. Medicare program is run by the federal government and individuals who are eligible for the program are those above 65 years of age, irrespective of their earning and young individuals who are disabled and have qualified for Social Security’s disability.

Medicaid on the other size is a health care plan run by the state and provides insurance cover for all income-based employees of all ages. One of the key strengths of both plans is that that they give individuals a chance for dual eligibility. It is essential to offer extensive acute as well as long-term health care services for dually eligible beneficiaries of both Medicaid and Medicare. One major weakness of Medicare is the fact that it does not provide insurance cover for services like acute care dental, transport services and vision services. The major service that is not covered by Medicare is long-term care. Moreover, it majorly covers for the elderly and does not serve the population that is below 65 years. Medicaid on the other part has a weakness in that it is more costly compared to Medicare. Moreover, unmarried patients must be financially broke in order to qualify for Medicaid. It is however evident that all services that are not covered by Medicare are paid by Medicaid health program. Medicaid and Medicare have been the principal means through which a large portion of the population gains access to health care in the United States.

It is however evident that Medicaid is more committed toward promoting health care access compared to Medicare. In the year 1960, about ten million United States’ citizens were enrolled in Medicaid. This number has gradually increased and currently, the program covers a total number of citizens exceeding forty one million. The minimal commitment of Medicare is owed to the fact that there has been no primary expansion of eligibility requirements from the 1970s. A good example of Medicaid expansion program that has led to increased accessibility to health care is the State Children’s Health Insurance Program. This program provides insurance cover to children from low-income families. With the ever-rising costs of health care, both Medicare and Medicaid health plans are struggling to establish equilibrium between access expansion and cost regulation. A major similarity between both plans is that the government funds them and they work in partnership to provide health care costs cover to the poor and elderly population. The cost growth risk is one of the consumer risks associated with both Medicare and Medicaid health care plans. Inadequate health care services, is a consumer risk associated with Medicaid.

With the increasing number of insured patients, there are inadequate primary care doctors. Physicians in majority of the states are discouraged by Medicaid health care plan. It is therefore common for individuals covered by Medicaid plan to report poorer health condition compared to the uninsured and those covered by private programs. A feature associated with Medicare program is prohibiting doctors from receiving health care payment that is more than the amount supposed to be paid by Medicare beneficiaries. It is thus not surprising to find some physicians refusing to provide health care services to Medicare patients on the grounds that the program pays an amount that is less than the costs. Fraud and waste, is another consumer risk that is associated with Medicaid and Medicare health care programs. With so many people enrolled in these programs, fraud is a common issue. The issue of waste and fraud is prevalent due to the fact that there is limited oversight to suppliers, providers and other people taking part in the health care plans. There are some recommendations that be suggested to improve the health care plan. One of the recommendations for Medicaid is to give greater support to uniform eligibility.

This would help in solving the issue of unmarried patients’ requirement to be low-income earners so as to be insured. Another recommendation is for the program to increase the amount of money paid to physicians taking part in the program. This would increase accessibility and the quality of health care services provided to Medicaid patients. Due to the fact that Medicaid is more expensive compared to Medicare, effort should be made to reduce the costs. This would also minimize the consumer risk of increased costs. One recommendation for Medicare program is expansion of coverage, access and eligibility requirements. Currently, only people aged 65 and above are eligible for Medicare cover. Including the rest of the population would promote accessibility to health care. Another recommendation is reduction in Medicare spending, which help in cutting down the costs of health care services for insured patients. It is also recommendable for Medicare to expand the range of services provided to beneficiaries. Long-term health care services and other services like transport services should be issued.

This is owed to the fact that the beneficiaries are the elderly population and disabled children who may have limited access to transportation facilities. In conclusion Medicare and Medicaid are two U.S. government programs that guarantee health insurance for the elderly and the poor, respectively. With Medicare, medical bills are paid from trust funds, which those covered, have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients.

Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government. Medicaid is an assistance program in which Medical bills are paid from federal, state and local tax funds. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. The state and local governments within federal guidelines run Medicaid.


1. Fong, Tony. (2005). Assessing Four Decades of Medicare, Medicaid, 6-7, 24, 42

2. Berkowitz, Edward (2008). Medicare and Medicaid: The Past as Prologue. Health Care Financing Review29. 3: 81-93

3. Carlson, G. (2009). Difference between Medicaid and Medicare. Health Feature articles

4. Medicaid and Medicare, pgs. 1-16

5. Pamela Farley Short, Lauren McCormack, Judith Hibbard, James A. Shaul, Lauren Harris-Kojetin, Michael H. Fox, Peter Damiano, Jennifer D. Uhrig and Paul D. Cleary (2002). Similarities and Differences in Choosing Health Plans. Medical Care, 40(4), 289-302

6. The Henry J. Kaiser Family Foundation (2009). Focus on Health Reform. Health Reform Opportunities: Improving Policy for Dual Eligible, pgs. 1-7

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