Medicare And Medicaid Programs: Benefits And Impacts
Medicare extends substantial reassurance from medical expenditure risk, protection that has increased in recent years. As pointed out by Barcellos, & Jacobson (2015), out of pocket expenditures drop by thirty-three percent at the mean and fifty-three percent at the ninety-fifth percentile when individuals turn sixty-five. At the age, medical-related financial strain, such as difficulty paying bills and collection agency contact, reduces dramatically. Nonetheless, the use of a stylized expected utility framework, out-of-pocket expenditure reduction gains account for only eighteen percent of social costs of financial Medicare. Notably, healthcare providers find that the majority of their income comes from the care and treatment of Medicare beneficiaries. It is a federal program covering all individuals above the age of sixty-five and other disabled fellows. Such a demographic group accounts for most users of healthcare than the other demographic brackets of young and healthier people. Medicare Part A covers not only inpatient services provided at the hospitals but also follow-up care.
Before Medicaid pays benefits directly, patients pay a deductible out-of-pocket expense. The deductible applies for each benefit period a period defined loosely as the course of treatment for a single medical condition. Once the patient pays the deductible, Medicaid covers all services for sixty days. After this period, the patient pays a set co-payment for each additional day. Patients using inpatient services for more than ninety days get higher co-payment charges. Moreover, those staying for more than ninety days get coverage limited on a lifetime basis. Medicaid provided reimbursements to hospitals basing on Diagnosis Related Groups (DRGs) where patient get charges depending on their medical conditions as it is in their medical records. Medicare Part B program provides reimbursements for services offered by physicians, nurses, therapist, nutritionists, counselors, and other licensed healthcare providers. It provides reimbursements for radiological and diagnostic laboratory tests as well as procedures performed in the outpatient setting. Patients pay a co-insurance of twenty percent in the case of mental health service, a forty-five percent in the case of mental health services. Patients face the responsibility of an annual deductible before they use this Medicare program. The program covers payments for prescriptions delivered by physicians in clinical settings as well as medical equipment that are durable. It is more of a fee-for-service model.
According to Barcellos, & Jacobson (2015), Medicare Part C is another program known as Medicare Advantage. The plan functions as a healthcare maintenance organization. While patients receive other Medicare programs, they may get a limited network of providers, and any additional services outside their specified network would result in higher charges. Medicare Advantage plans come in handy for such a circumstance. It provides plans for services not covered in other plans. Medicare Part D formulates standards and organizes drugs in tiers. Accordingly, tiers may either have or may not have co-pay. Some may have higher billing costs than others. However, the billers who work for pharmacies serve the outpatient services. They cover medications usually administered by patients themselves. Medicare, therefore, offers substantial protection against the immense out of pocket expenses. Even though this effect varies by the patient’s socioeconomic status, declines in out-of-pocket spending center on more educated, while a reduction in the effects of financial strains is more on the least educated.
Qualifications for Benefits
Medicare was established as a federally funded healthcare program for older, disabled, or chronically ill people. Individuals above sixty-five years and meet these requirements will receive social security benefits and/or railroad retirement benefits, spouse (living or deceased, including divorced spouses) receives or is eligible to receive social security or retirement benefits, self or spouse worked long enough in a government job through which they paid Medicare taxes and dependent parent of a fully insured deceased child. These individuals will be eligible for Part Medicare benefits. Individuals under the age of sixty-five meeting the above conditions would receive social security disability benefits for at least two years, receive a retirement pension from the work retirement board, have Lou Gehrig's disease (ALS), were employed in the government job through which they paid Medicare and taxes and were entitled to Social Security disability benefits for two years, are child or widow(er) age fifty or older, including a divorced widow(er), of someone who meets the above qualifications, have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and meet the above qualification. Parts B, C, and D would cover any individual who is eligible for Medicare hospital insurance. Those with Parts A and B can join the Medicare Advantage plan. Anyone with Part A or B is eligible for prescription drug coverage. Medicaid is a state-administered healthcare program for people with limited incomes and resources. It covers individuals with income below thirty-three percent of the federal poverty line. States set specific qualification criteria within federal minimum standards and can apply for reservations. It covers parents whose earnings are within the state eligibility limit for cash assistance that was in place before welfare reform. It covers most elders and people with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program. Notwithstanding, individuals must meet both state and federal requirements regarding residency, immigration, and documentation of citizenship of the United States.
Impacts of ACA on Medicare and Medicaid
The affordable care put in place fundamental tax-related programs that impact both Medicaid and Medicare significantly. It has resulted in increased medical taxes on earned and unearned income for high-wage earners, and other medical changes that increase the number of insured individuals. Since 2013, higher-income taxpayers' medical tax has increased. Such individuals pay 0. 9% extra on Medicare taxes. It imposes a 3. 8% tax on unearned income as a Net Investment Income Tax. It has put in place means that allow Medicaid to ensure a huge number of previously uninsured individuals. It has also changed the Children's Health Insurance Program (CHIP) and has placed it under the Medicaid docket. Individuals with incomes within 133% of the federal poverty level with have their children covered under the Medicaid program.
References
- Barcellos, S. H. , & Jacobson, M. (2015). The Effects of Medicare on Medical Expenditure Risk and Financial Strain. American economic journal. Economic policy, 7(4), 41–70. doi:10. 1257/pol. 20140262
- Graves, J. A. , & Swartz, K. (2017). Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care. Cancer journal (Sudbury, Mass. ), 23(3), 168–174. doi:10. 1097/PPO. 0000000000000260
- Ndumele, C. D. , Sommers, B. D. , & Trivedi, A. N. (2015). The ACA's 65th Birthday Challenge: Moving from Medicaid to Medicare. Journal of general internal medicine, 30(11), 1704–1706. doi:10. 1007/s11606-015-3328-0
- Zheng, N. T. , Haber, S. , Hoover, S. , & Feng, Z. (2017). Access to Care for Medicare-Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies. Health services research, 52(6), 2219–2236. doi:10. 1111/1475-6773. 12591
