The cost of healthcare is rapidly increasing while affordability shrinks. In 1965, July 30, President Lyndon B. Johnson signed into law what will become Medicaid and Medicare. These insurance programs originally had two parts: A (Hospital Insurance) and B (Medical insurance). Congress has made changes to the scope and eligibility of Americans for the services of the programs. The children category was created in 1997 called the Children's Health Insurance Program (CHIP) to be part of Medicaid. It is to offer health insurance and preventive care to millions of America's uninsured children. All states have CHIP plans.
Medicaid has expanded from only giving people that are getting cash assistance to low-income families, people with disabilities, those with long-term care, and pregnant women. The non-elderly adult has become eligible for Medicaid. In 2010, the Affordable Care Act (ACA) created more opportunities for people to access, enroll in personal health insurance cover and improved coordination between Medicaid and Medicare (Miller, & Wherry, 2017). The different financial strengths of various states and the law allow states to design their Medicaid program per their capacity. However, the federal agencies oversee the compliance of states according to federal guidelines. Medicaid insurance cover is one of the best because of its lower cost compared to the commercially available insurance covers.
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Medicaid has improved in certain areas. Many people in the country have been connected to the program. The program coordinates with states to enlighten service consumers, enroll, and streamline payment systems. The benefits and access to healthcare services have been strengthened. Medicaid promotes cost-effective care to consumers of its services and encourages innovations tailored to better health for Americans (DeWalt et al., 2005). Also, it has improved in community-based and traditional care especially for seniors and people with disabilities. This step is aimed at long-term services and support of the population in need of its services across the country.
Medicare has also gone through changes and expansion. It is distinct from Medicaid but now connected in some way. Also, it is under the federal government. In 1972, Medicare was expanded to include three sets of people, those with end-stage renal disease in need of dialysis or kidney transplant, the disabled, and those that are 65 years or above who choose its coverage. It has a three-part coverage structure. Part A (Hospital Insurance) is the part that covers inpatients services and skilled nursing facilities but not inclusive of long-term care. Part B (Medical Insurance) is the part that includes doctors, healthcare providers, and outpatient services. It helps cover for what part A has not covered such as home healthcare. Most people enroll in part B. Prescription drug coverage was added to the eligibility criteria. Medicare Part C is a managed care option called Medicare Advantage (MA) under contractors. It combines features of A and B, often including prescription drugs. The Medicare Part D Prescription Drug benefit came under the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). The optional prescription benefit in part D entered into effect in 2006.
Medicare operates through a contribution by beneficiaries of its services. It addresses the medical bills of the elderly and a particular group of disabled people. Run by the federal government, the consumers of the services pay through their payrolls and employment taxes. People can qualify for both but must meet the requirements for eligibility set by each program. The rules or conditions for Medicare are the same across the country. The social security administration can cover someone under Medicare if they have a disability that places them under 65years. Medicare has a yearly deductible for all its coverage. However, Medicaid can defray the cost of deductibles and premium charges which Medicare will not pay.
References
DeWalt, D. A., Oberlander, J., Carey, T. S., & Roper, W. L. (2005). Significance of Medicare and Medicaid Programs for the Practice of Medicine. Health Care Financing Review, 27 (2), 79–90.
Miller, S., & Wherry, L. R. (2017). Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions. N Engl J Med , 376 :947-956. DOI: 10.1056/NEJMsa1612890
