Policy BP7: Medicaid & Medicare

Policy BP7: Medicaid & Medicare

Describe Medicaid & Medicare, including how they are administered, who they cover, eligibility, and efforts to cut costs in each program.

I used to get Medicaid and Medicare mixed up. I have benefited from the mnemonic device “you (medi)CARE for the elderly, you (medic)AID your child”.

Medicare is an insurance program and the largest public payer of health care in the United States. It provides the elderly (65 and older) health insurance. It may also cover those with certain disabilities, renal failure, and Lou Gehrig’s disease. It has several parts. Part A: Hospital Insurance, Part B: Supplemental Medical Insurance (SMI), Part C: Medicare Advantage program, Part D: Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Presuming one qualifies for medicare, Part A is at no cost. Parts B-D require monthly premiums for the extra coverage they provide. Medicare is financed through the US Treasury for Part A, B, and D. According to Karger and Stoesz (2013), Part D cannot curb rising drug costs because Medicare is prohibited from negotiating lower drug prices.

Medicaid is a health insurance program funded jointly by the state and federal governments. It is a means-tested assistance program, meaning that the eligibility is determined on the basis on financial need. However, each state is able to pick its own eligibility threshold, the duration, and scope of services (2013). A federal guideline for eligibility includes medicaid coverage to anyone receiving federal assistance. This eligibility mainly targets poor children, foster children, poor pregnant mothers, and those receiving SSI. To cut costs, states set very hard to reach eligibility thresholds and some states have refused to adopt medicaid expansion. As a result, there are gaps in care and coverage (Karger & Stoesz, 2013).

Karger, H. J., & Stoesz, D. (2013). American social welfare policy: A pluralist approach (7th ed.). New York: Allyn & Bacon.

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