Salient Factors for Medicaid and Medicare

There is no denying that Medicaid and Medicare sound the same. However, these United States governments health insurance programs are quite different from each other. Medicare is a federal program that mainly targets adults aged 65 years and above who have contributed to the Social Security System for not less than 40 quarters. All in all, a person who does not have the required work credits can also benefit from this program via his or her spouse. Others who can benefit are individuals aged below 65 years but have been recipients of Social Security Disability Insurance payments for not less than two years. Medicaid is a federal-state program that acts mainly as a safety net for individuals who cannot afford healthcare.

The two programs were founded in 1965 as a response to the fact that most elderly and low-income Americans were unable to purchase private health insurance cover. They were part of the so-called Great Society vision by President Lyndon Johnson of a general social commitment to satisfy peoples healthcare needs. They are social insurance programs that make it possible for financial burdens of sickness to be shared among ill and healthy individuals together with low-income and wealthy families.

Medicare is made up of different parts. Part A covers mainly in-patient care while also offering a minimal benefit for hospice and skilled nursing care. Part B handles outpatient care costs such as preventative care, laboratory tests, and visits to a physician. Part C is referred to as the Medicare Advantage program and offers a substitute to parts A and B. as is the case with most kinds of insurance, the three parts include deductibles and co-pays. The level of an individuals income and amount of assets owned do not matter. This means that wealthy and poverty-stricken individuals are equally eligible.

Since Medicare is mainly a program for people aged 65 years and above, it covers just a tiny portion of the costs incurred during a nursing home admission. What it does is that it covers all the costs incurred during the initial twenty days when a patient is admitted and partial coverage for the next eighty days. However, for the admission to be covered, the patient is expected to satisfy certain requirements. For instance, he or she must have been hospitalized for not less than three days before being sent to a nursing home to receive care. In addition, such care should be in one way or another medically necessary. Due to such requirements, a patient or his/her family are often forced to use their own money to pay for nursing home care. The alternative is to get a reprieve from Medicaid.

Senior citizens can take part in Medicaid if they successfully pass three tests: an asset, a medical necessity, and an income test. An asset test sets a strict limit on the amount of property a patient and his or her spouse can own while enjoying the programs benefits. The medical necessity test is meant to prove that skilled nursing care is needed to handle medical needs of the patient. The income test sets limits on the level of individuals and couples income for them to qualify for Medicaid. For those who fail the tests but need Medicaid to help offset the costs incurred during a nursing home admission, there are certain ways to get around them. However, it may require hiring the services of a lawyer. A certain section of the Elder law can assist people to preserve their assets and still be eligible for Medicaid.

References

Altman, D., & Frist, W. H. (2015). Medicare and Medicaid at 50 years: perspectives of beneficiaries, health care professionals and institutions, and policy makers. Jama, 314(4), 384-395.

Centers for Medicare & Medicaid Services (CMS), HHS. (2015). Medicare and Medicaid Programs; Electronic Health Record Incentive Program--Stage 3 and Modifications to Meaningful Use in 2015 Through 2017. Final rules with comment period. Federal register, 80(200), 62761.

Rajaram, R., Chung, J. W., Kinnier, C. V., Barnard, C., Mohanty, S., Pavey, E. S., ... & Bilimoria, K. Y. (2015). Hospital characteristics associated with penalties in the Centers for Medicare & Medicaid Services hospital-acquired condition reduction program. Jama, 314(4), 375-383.

Riley, G. F., & Rupp, K. (2015). Cumulative Expenditures under the DI, SSI, Medicare, and Medicaid Programs for a Cohort of Disabled WorkingAge Adults. Health services research, 50(2), 514-536.