Reference no: EM133196355

Assignment - Medicare and Medicaid Discussions

Discussion 1 - Medicare and Medicaid

Medicare is the insurance program that pays medical bills from the trust funds. Medicare is mainly used to serve older people, those over 65 years old, dialysis patients, and the younger disabled persons (El-Nahal, 2020). Medicare is a federal program that aims at helping patients pays their medical bills. On the other hand, Medicaid is an assistance program that serves low-income individuals of any age (Brown et al., 2021. The patients are expected to pay some of the costs, and Medicaid covers the rest of the bills. Both Medicare and Medicaid programs help enhance patient care by ensuring that eligible patients receive quality care despite their low finances.

The first component of Medicare and Medicaid is offering inpatient services. Sometimes the coverage extends overnight depending on the urgency of the matter (Brown et al., 2021). Following this, the healthcare provider will be paid depending on the services they provide to the patient. However, in Medicare, inpatient services as restrictions make it easy to contain the costs and enhance quality care. For example, the service provider is not paid by Medicare if the patient goes back to the hospital within 30 days for the same procedure. On the other hand, Medicaid covers inpatient and outpatient medical expenses for the patient. This measure ensures that the health service provider attends to the patient fully and provides the required medications so that they do not have to return within thirty days.

According to El-Nahal, (2020), another component of Medicare and Medicaid is covering prescription drugs during healthcare. This makes it easy for the persons covered to access all the medications, enhancing quality care. The third component is that Medicare and Medicaid Services cover occupational, physical, speech therapy, and x-ray services. Besides, patients are provided with durable medical equipment like walkers and canes (Brown et al., 2021). However, it is also important to note that Medicaid covers all the people who have problems accessing healthcare services, unlike Medicare which only covers the elderly, the disabled young, and the dialysis patients. Following this, both Medicare and Medicaid ensure that patients receive quality care services from the healthcare institutions regardless of their financial constraints.

Discussion 2 - Components of Medicare and Medicaid Programs

Medicare is federal health coverage for specific populations, including individuals aged 65 or older, those living with certain disabilities, and individuals living with (ESRD) (CMS, 2022). In contrast, the Medicaid program is a federal and state health coverage for vulnerable populations, including individuals living with disability, the elderly, pregnant women, low-income adults, and children (CMS, 2022). Notably, the main components of the Medicare program include Part A, which provides hospital insurance (Medicare, 2022). The hospital insurance covers inpatient care services, nursing facility care, hospice care, and home health care. The second component is Part B which constitutes medical insurance that covers outpatient care, home health care, durable medical equipment, and preventative care such as vaccines and screening (Medicare, 2022). The third component is Part C, which constitutes Medicare Advantage. The fourth component is Part D which includes drug coverage, covering costs accrued in prescription drugs (Medicare, 2022). Regarding Medicaid, it offers benefits such as personal healthcare services, nursing home care, and it also provides help in paying for Medicare premiums and other health costs.

Patient Coverage Gaps - Evidence suggests that the drug coverage plans have a coverage gap which is commonly referred to as the "the donut hole" (Medicare, 2022). The respective coverage gaps mean that individuals encounter a temporary limit on specific drug plans. In addition, not all persons are eligible for the coverage gap because it only begins when a certain amount for covered drugs is spent. In 2022, individuals will enter the coverage gap when they spend approximately $4430 on covered drugs (Medicare, 2022). In addition, Medicare only pays 75% of the costs for generic drugs, while an individual pays for the remaining 25% (Medicare, 2022). Further dimensions that are part of the coverage gap include an individual's yearly deductible, coinsurance, and copayments. An additional coverage gap is included in Part B of the Medicare program, where most people have to pay a monthly fee or a premium to access some of the covered services. The primary coverage gap in the Medicaid program occurs through the Medicaid expansion issue (Medicaid, 2022). According to research, impoverished people with poor earnings living in states that are yet to implement the Medicaid expansion encounter the coverage gap because they are ruled out of the Medicaid program (Medicaid, 2022). Accordingly, the vulnerable populations are likely to remain uninsured increasing health disparities in specific states (Medicaid, 2022). Notably, extending health coverage in the coverage gap benefits individuals with incomes below the poverty line, it will save lives, reduce costs and help eliminate health inequality in the US.

Relevance of the Social Security Program - There are millions of Americans receiving Social Security benefits, as such, it is a critical program that should be strengthened for more benefits to Americans. The Social Security program offers security and stability to vulnerable populations such as retired individuals, persons living with disability, children, and widowed partners. Approximately 61 million Americans receive increased benefits from the program (NASI, 2022). Moreover, about 87% of Democrats, 71% of Republicans, and 81% of Independents support the Social Security program (NASI, 2022). Furthermore, the program has an audience willing to pay more in the United States because of its value to themselves and their families. Notably, I believe the program should be left alone, and more policies should be implemented to strengthen its relevance.

Reply to each discussion with one paragraph and 1 credible resource.