Medicare vs. Medicaid
Despite the fact that the United States of America is the wealthiest nation in the world, its healthcare system is nowhere near the best. For many people, health insurance is unaffordable, and there are millions of people who lack basic health insurance. As a result, there are many people who either die of treatable diseases, or overburden the health system by seeking medical attention when they are in a critical condition. Realizing the danger that lack of a proper healthcare system in the US may bring forth, the federal government has come up with a raft of measures aimed at lessening the burden on its citizens. Among all these initiatives, Medicaid and Medicare remain the most popular because of the huge number of people they support. Fundamentally, Medicare and Medicaid serve different purposes, but both programs have the ultimate aim of making healthcare accessible to their target groups.
Medicare, in simple terms, refers to a federal government-sponsored healthcare program which is primarily used by seniors above 65 years of age. It also serves people under the age of 65 years, as long as they have end stage renal disease, or they are affected by certain disabilities. Medicaid, on the other hand, is a program sponsored by the federal and the state governments to make healthcare accessible to low-income families. Apart from the differences in the source of funding, eligibility criteria, and the beneficiaries, Medicare and Medicaid programs also differ on their strengths, weaknesses and incentives.
One of the things which make Medicare indispensable is its “friendly” fee structure, less restriction, and wide coverage among many of America’s seniors above the age of 65. The administration of Medicare is also easy. It is on the basis of these strengths that Medicare has received wide acceptance among the public. On the other hand, Medicaid also has its own strengths. For example, clients pay less to access some services which would normally cost more under private insurance. Moreover, the clients can choose between one of the two different health plans and determine the provider of their choice. The Medicaid health cover also means that the clients do not have to pay for some services using out-of-pocket fees. Nonetheless, the same qualities which make both Medicare and Medicaid wonderful also have some weaknesses.
In the Medicare program, for example, patients and medical professionals do abuse the system. This normally occurs when patients use doctor visits to fill their time. The doctors also use this loophole to pacify the patients and add more revenue to their hospitals since all the procedures and tests ordered by the doctor are covered by the Medicare. For the patients facing terminal illnesses, the doctors may also order numerous procedures which may not improve the patient’s quality of life instead of sending them to the hospice. The weaknesses faced by the Medicaid program include underfunding, and this usually limits the number of providers a state may hire. Again, the Medicaid program varies from state to state since each state runs its Medicaid program. Therefore, the coverage and policies in some states may be better than in other states. Despite the weaknesses inherent in both the Medicare and the Medicaid programs, the benefits outweigh the disadvantages by far. One of the things which make this possible is the incentives provided by each program.
In the recent past, a Medicare and Medicaid electronic health records program has been created to encourage eligible hospitals and professionals to use electronic records instead of instead of paper records. This arises from the realization that some patients, medical professionals, and hospitals were using the paper records to rip off the program. In some cases, the use of paper records had denied legitimate participants the services they had registered, while in other cases, some undocumented immigrants had used the loopholes in the paper records system to access services they should not have access to. This incentive aims to reimburse hospitals and eligible medical professionals the costs incurred in the purchase and replacement of electronic health records. Apart from the incentives provided, there is also a genuine commitment to make both programs accessible to their target groups.
It is common knowledge that Medicare and Medicaid programs are not meant to cover all the Americans, but to benefit a certain group of people. Medicare targets seniors above the age of 65, and it has four parts, with each part having its own set of requirements. Each category also has its own defined benefits. Going by the number of seniors enrolled into the Medicare, there is a strong commitment to access the program, and the numbers keep on increasing. On the other hand, Medicaid is meant to benefit families with low incomes. Families receiving social security support, and with assets of value which is less than $ 1,000 are eligible to enroll for the program. Nonetheless, the eligibility criterion is strict, and some families which cannot afford private insurance are left out. In some states, the program has also been underfunded, therefore limiting the number of service providers a state can hire. It is also important to note that both programs have risks associated with them.
The Medicare program, for example, does not cover all the medical costs. This is prevalent for participants enrolled for part A and part B of the Medicare program. Therefore, the individuals covered must pay for some services out-of-pocket. Medicare can also refuse to pay for services it deems unnecessary. On the other hand, some of the risks associated with Medicaid include limited number of service providers. Therefore, the individuals covered do not have the freedom to choose their preferred doctors and hospitals; they have to choose from the list provided. Both Medicaid and Medicare programs have been useful to the American citizens, but some improvements are necessary.
One of the means to improve both Medicare and Medicaid is through addressing the challenge of inefficiency which leads to high cost without improving the quality of healthcare. The current healthcare system has a lot of inefficiencies which do not necessarily improve the quality of healthcare and these needs to be addressed. If unchecked, these inefficiencies will increase the cost of healthcare, and hit unsustainable levels. There is also need to strengthen the financing of both the Medicare and Medicaid programs such that they can adapt to the changing economic times without placing the beneficiaries at risk. With a strong financial backing, the programs can increase the eligibility criteria and cover thousands of people who are not insured. The last recommendation relates to service delivery. There is the need to address communication problems for clients with limited English proficiency. There are thousands of Medicare and Medicaid beneficiaries who cannot communicate effectively with the healthcare professionals, and this has been associated with poor health outcomes in the past. The Medicare program is trying to address this challenge, but more can be done.
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