Medicaid and Medicare Definition and Comparison

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Medicaid and Medicare Definition and Comparison

Introduction

Purpose of Medicaid and Medicare

Medicare and Medicaid are programs designed to ensure that low income and elderly Americans access health insurance. The programs ensure that the financial burden of low-income Americans is shared among all citizens (Cubanski et al., 2015). The main goal of the programs is to reduce health inequity. The two insurance programs are run by the federal and state governments and provide care to people with disabilities and the elderly.

Differences between Medicaid and Medicare

Medicare is run by the federal government and it covers healthcare both for seniors and people with some types of disabilities. It covers people who have severe mental and physical disabilities regardless of socio-economic status. The insurance program also covers limited home and nursing health care. On the other hand, Medicaid is run through a collaboration between the state and federal governments. It targets people who have no access to private health insurance. For example, it covers poor children and people with significant healthcare needs who require specialized services. Most people with mental illnesses are eligible for the program.

Policy issues act as the major barriers to accessibility. This is in relation to eligibility requirements. For example, in the Medicare plan, the same level of care irrespective of the socio-economic status of the patient results in inequalities. In addition, the complicated application process, difficulties in finding translators to help in the application process are other enrollment barriers to the programs (Hernandez & Curtis, 2011).

Description

a- Medicare part A and Medicare part B

The differences in Medicare A and Medicare B relate to the services they cover. Part A covers hospitalization expenses, long term care rehabilitation facilities, and some stays in hospice. On the other hand, Part B pays some part of the doctors visit, medical equipment, outpatient care, laboratory tests, mental health services, rehabilitation services, and ambulance services. In the Part B plan, people who do not meet the employment criteria are supposed to make monthly repayments.

Developing Objectives Based on the Article

Limitations between patient A and patient B

The level of the patient policy provides equal allocation of funds to all patients without considering socio-economic status, demographic and ethnic differences. This leads to the creation of inequities in the care provision (Berenson & Shih, 2012). For example, even though patients may present similar disease characteristics, there are variables that influence the health status of the patients. In relation to Patient A and Patient B, Patient A is likely to be readmitted due to socio-economic factors that make him more vulnerable to health issues.

Socioeconomic circumstances for patients

Patient A has a high socioeconomic status. In relation to education, he holds a doctoral degree. Besides, he can afford private insurance, enjoys ample coverage for prescription drugs, and stays with his wife. This is unlike Patient B who did not complete high school education, lives alone, and does not have ample coverage for his prescription. Based on the socioeconomic difference, Patient B is more likely to be readmitted compared to patient A who has regular checkups from the personal physician.

Policy Limitation to decrease the Medicare Hospital

Readmission

The current policy measures entail a coordinated care program in which hospitals and post-discharge providers work together to improve the quality of health care as a measure to reduce the readmissions. Home-grown programs that ensure that care is given at home to reduce the readmission are other measures. These measures should be based on the application of evidence-based practices in order to ensure quality care delivery.

Strategies to overcome barriers affecting accessibility to Medicare health plans.

Policies should be formulated to ensure that the care plan allocates resources based on the socio-demographic factors of the beneficiaries. This will ensure a customized program where the people from low-socio-economic factor and those who have no alternative insurance have more allocations as a measure to reduce the health disparities.

Conclusion

The following recommendations should be undertaken to improve accessibility to Medicaid-Medicare Health Plans:

Medicare should be redesigned to capture the socio-economic differences of beneficiaries.
The health facilities that serve low socio-economic communities should not be penalized on the basis of readmission rates, instead; federal laws should be amended to increase allocations for the beneficiaries who have low socioeconomic status.
Federal laws should be amended to ensure flexible payment structures for Medicaid; the prospects for bundled rates should be implemented in a manner to ensure flexibility and reimburse for care services that entail several specific interventions.
Eligibility to Medicaid should include all adults with incomes that are considered to be below the federal poverty line.

References

Berenson, J., & Shih, A. (2012). Higher readmissions at safety-net hospitals and potential policy solutions. Issue Brief, 34(1), 1-16.

Cubanski, J., Swoope, C., Boccuti, C., Jacobson, G., Casillas, G., & Griffin, S. (2015). Primer on Medicare: Key facts about the Medicare program and the people it covers. Web.

Hernandez, A. F., & Curtis, L. H. (2011). Minding the gap between efforts to reduce readmissions and disparities. Jama, 305(7), 715-716.

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