Medicare And Medicaid Essay

2152 words - 9 pages

Statement of Problem

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.
Medicare was ...view middle of the document...

Medicare and Medicaid’s sustainability relies greatly on funding in order to provide health care.
Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

Analysis of Medicaid Funding

Medicaid provides a comprehensive benefit package for those who enroll. The federal government requires coverage of thirteen services, including inpatient and outpatient hospital services, nursing home and home health care, and for children under the age of twenty-one. The benefits do not end there, Medicaid offers a plethora of optional packages that include prescription drugs, dental services, care for the mentally challenged, and optometric services. While these optional packages are not offered in all states, Medicaid must cover these costs if the beneficiary decides to enroll. These benefits must be provided at no cost to children and women who are pregnant, with only a small copayment, which the federal government has deemed to be no more than three dollars. Enrollees face no premiums, and in some states enrollees do not have to meet deductable before their coverage begins (Weil, 2003). The Federal government has given the states the authority to determine the amount of coverage, the duration of coverage, and the scope of which the insurance will cover. It is not uncommon to see states limiting the number of prescriptions, or shortening hospital stays or defining how many times a nurse can visit a patient’s home in one month. This call to power limits the coverage of Medicaid beneficiaries and does not allow enrollee’s to have much say in their own health care. Medicare expands beyond the poorest population, yet the program is designed to reflect the needs of the population it serves.
Medicaid is one of the several components that make up the nation’s health care system. It has grown exponentially over time and now provides health care benefits for nearly sixty million people. A program of this magnitude touches on every aspect of economic life, affecting beneficiaries to the government. Medicaid has become a major expenditure for the state government; a large fraction of state Medicaid spending is...

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