Medicare and Medicaid Overview

Topics: Health insurance, Health care, Medicare Pages: 7 (2781 words) Published: June 30, 2013
Medicare and Medicaid:
An Overview

It is important that we all understand the basics of the Medicare and Medicaid programs as we will all eventually come of age where it is necessary to seek their assistance. The purpose of this paper is to give a brief history of how the program came about, the various plans for each program, issues that affect cost and access to the programs, how the political arena is affected and finally a conclusion with final thoughts on the total information.

The idea for a national health insurance program was first introduced by President Truman in 1945 but so much debate went back and forth that it was two decades later and a different president before they were actually signed into law. President Johnson signed them into law in 1965 with Harry Truman being the first enrollee. Starting in 1972 several changes were made over the next couple of decades. For example, in 1972 disabled persons under the age of 65 and those with end-stage renal disease become eligible for coverage and services expanded to include some chiropractic services, speech therapy and physical therapy. Payments to HMOs were authorized and the Supplemental Security Income (SSI) program was established for the elderly and disabled poor, SSI recipients were automatically eligible for Medicaid. These were just the changes made in that year alone. The 1980’s saw the most amount of changes to the programs with hospice benefits added, prescription drug costs covered, federal civilian employees covered and other changes (, 2008). The 1990’s saw some changes in the healthcare system as a whole during the Clinton administration and then a stall during the Bush administration. Now that we have started the Obama administration and healthcare is on the top of everyone’s list along with the economy it will be interesting to see what he does. Medicare has several different plans which make up the total program. Part A is hospital insurance and is already paid for by the taxes you pay during your working years. Part B is health insurance and usually requires a monthly premium and covers what Part A does not. For example Part A covers inpatient hospital stays while Part B covers outpatient procedures. Part C is Medicare Advantage, formerly known as Medicare + Choice. Medicare Advantage is very much like a private health insurance plan, offering managed care, PPO, and fee-for-service coverage options. It is only available in certain regions of the country, and the premium is higher than that charged for Part B, but it does offer the convenience of packaging Part A, Part B, and additional coverage into one neat bundle. The Prescription Drug plan also requires a monthly premium and as of 2006 is eligible for anyone who has Medicare. This is also known as Plan D. Medicare is for people 65 or older, under 65 with disability and (surprisingly enough) anyone who is on kidney dialysis or has had a kidney transplant (Medicare Overview, 2005). This last point surprised me when I read it because I did not know that this was a special category all its own. Eligibility for Medicaid works a lot differently than for Medicare because there is no set age (Medicare Advocacy, 2008). In fact this program is directed towards low income families and individuals who meet eligibility requirements set up by the states. Some of the criteria look at disability, income, citizenship and who lives in the household with you. If you meet the criteria then Medicaid sends payments to the health provider instead of directly to the beneficiary. This program can supplement what Medicare does not pay if it meets the requirements. Medicaid also works differently than Medicare because there are no plan distinctions. One item is clear, you have to be eligible for Medicare in order to be eligible for Medicaid. This program works hand in hand with Medicare, it does not act as an alternate. This means that these two programs are...

References: (2008, November 12). Brief History of the Medicare Program. Retrieved March 8, 2009, from Web site:
(2009). Disease Management (Health). Retrieved February 12, 2009, from Web site:
(2009).Disease management approach in Medicare needs work. American Journal of Health-System Pharmacy. 66, 327-328.
(2005, December 14). Medicare Program - General Information. Retrieved March 8, 2009, from Web site:
(2008, May 5). What 's the Difference Between Medicare and Medicaid. Retrieved March 8, 2009, from Medicare Web site:
Negotiate for what?: House Democrats have approved a Medicare bill. Too bad they put politics ahead of cost savings. (2007, January 17). Akron Beacon Journal (OH), Retrieved March 8, 2009, from Newspaper Source database.
O 'Brien, Ellen (2005).Medicare and Medicaid: Trends and Issues Affecting Access to Care for Low-Income Elders and People with Disabilities. Insuring Health and Income Security. 65-69.
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