Medicaid and Medicare Healthcare Programs

The modern world is faced with several health challenges that have been aggravated by the change of lifestyle in society. Nowadays, individuals no longer involve themselves in body exercises leading to increased chronic illnesses such as cancer in people of all ages (Berkowitz et al., 2018). The high prevalence of illnesses, therefore, has led to the high cost of living due to the huge medical bills incurred. Due to the rise in medical bills, Medicaid and Medicare were introduced to help in the reduction of burdens brought about by the huge medical bills. 

Medicaid and Medicare Programs

Both Medicare and Medicaid programs are the healthcare initiatives developed by the federal government in 1965. Medicaid is a state and federal healthcare initiative that provides patients earning low income with health care coverage (Berkowitz et al., 2018). On the other hand, Medicare is a federal program providing health care coverage to the elderly people who are 65 years and above, as well as, people living with disabilities and cannot provide for themselves. Notably, Medicare does not consider the income of the patients they are covering. 

Eligibility for Medicare and Medicaid benefits

Medicare eligibility 

Patients under the Medicare program are enrolled in part A and part B when getting healthcare services. Part A of the Medicare program only covers inpatient services where patients are admitted for a night and are released upon getting treatment. The part also covers elderly patients in nursing homes for long durations. On the other hand, part B covers the medical procedures that are not covered under part A including x-rays, nursing care services, and the physician services. 

Therefore, for a patient to be eligible for a Medicare program he or she should be 65 years old or above. A patient must be disabled permanently for a period of more than three years and should be receiving disability benefits from the government. Moreover, patients with end-stage renal disease (ESRD) who are in need of a kidney transplant are automatically enrolled for a Medicare program. Lastly, all patients suffering from any of Lou Gehrig’s diseases are eligible for Medicare coverage. 

Medicaid eligibility 

The eligibility for Medicaid services differ with the state, but there are universal qualifications across all states. In particular, for a patient to get Medicaid coverage, he or she should be a low-income earner who cannot afford to pay for his or her medical bills. In addition, to be enrolled with a Medicaid program on has to be a full American citizen (Grabowski, Joyce, McGuire, & Frank, 2017). Both elderly and disabled people are automatic beneficiaries of the Medicaid program without any compromise. People battling with chronic illnesses like cancer are also beneficiaries of Medicaid coverage. Lastly, all people who qualify for the Medicare program are automatically eligible for a Medicaid cover. 

Effects of Medicare on billing 

Medicare has positively affected the billing at the health care facilities making it easy to offer treatment to patients. Notably, Medicare caters for the major costs in a hospital, thus, reducing the burden of medical bills on patients. Medicare caters for all the prescribed drugs available at a health facility at full cost (Danagoulian, Janke & Levy, 2018).  In addition, all the pediatric costs incurred in the hospital are fully settled by the Medicare program. Medicare also pays in full costs incurred when treating the mentally challenged patients. Family planning services to both male and female are fully covered under the Medicare program. Along with that, patients undergoing occupational, physical, and speech therapies are fully catered for by the Medicare initiative. All inpatient and outpatient services are fully waived under the Medicare program to all the eligible patients. Lastly, mouth related problems and dental medical care are fully covered by the Medicare initiative, thus, reducing bills on patients. 

Impact of ACA on Medicaid and Medicare recipients

 The Affordable Care Act (ACA) is a healthcare reform and exhaustive law implemented in 2010 in America. The ACA law is also referred to as Obamacare since it was introduced during his tenure. The main goal of the introduction of the ACA reform was to ensure that all citizens in America had health care insurance. In addition, the ACA reform ensured that there was an expansion of the Medicaid program to all the health care facilities. Lastly, the ACA reforms introduced health care methods that were innovative and supportive in the reduction of health care costs. 

Consistently, the ACA reforms had other major impacts on Medicaid that positively influenced healthcare, thus, improving the living standards of the U.S. citizens. To start with, ACA ensured the number of enrolled people was increased by extending outreach to society. In addition, all the individuals enrolled with Medicaid were entitled to the state plan benefits, as well as, being exempted from the Alternative Benefit Plan (ABP). The ACA reforms ensured all the low-income earners were enrolled in the Medicaid initiative without discrimination (Card, Dobkin, & Maestas, 2018).  The ACA reforms reached out to the American citizens living with disabilities to register with the Medicaid initiative, thus, reducing their burden of buying drugs and paying for therapy services. Through the introduction of the ACA reforms, the number of elderly patients and children under health insurance reduced. All the poverty-related Medicaid coverages were renewed allowing patients to get their services at little or no health care costs. The patients enrolled with Medicare were given an allowance to apply for the Medicaid enrollment. Eventually, the ACA reforms gave room to all the American citizens to enroll in the Medicaid program even without revealing their level income.

Conclusion

Based on both the Medicare and the Medicaid analysis, it is evident that these initiatives have positively influenced the health status of the American citizens. In addition, the introduction of both Medicaid and Medicare has greatly helped in the containment of chronic illnesses due to cost reduction. People living with disabilities also have an advantage of receiving healthcare services at no cost, thus, improving their health status. Improving the health status of both the elderly and the disabled has positively influenced their relationship with the members of the society. The introduction of the ACA has positively influenced both Medicare and Medicaid programs, thus, helping the American citizens to overcome the challenges associated with health. Therefore, the introduction of ACA, Medicare, and Medicaid has positively influenced the economic growth in America and reduced the mortality rates. 

References

Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky, T., Tishler, L. W., & DeWalt, D. A. (2018). Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries. Health Affairs, 37(4), 535-542.

Card, D., Dobkin, C., & Maestas, N. (2018). The impact of nearly universal insurance coverage on health care utilization: evidence from Medicare. American Economic Review, 98(5), 2242-58.

Danagoulian, S., Janke, A., & Levy, P. (January 01, 2018). Medicaid Expansion After the ACA: Intensity of Treatment and Billing in Emergency Departments. Ssrn Electronic Journal. http://dx.doi.org/10.2139/ssrn.3251557.

Grabowski, D. C., Joyce, N. R., McGuire, T. G., & Frank, R. G. (2017). Passive enrollment of dual-eligible beneficiaries into Medicare and Medicaid managed care has not met expectations. Health Affairs, 36(5), 846-854.