Before 1965, individuals had the responsibility of catering for their medical expenses. Those citizens with financial difficulties inevitably experienced poor healthcare services due to the ever-increasing costs. Government programs of healthcare payment such as Medicare, Medicaid, and Medigap were hence introduced. They aimed to reduce healthcare inequality by ensuring that every citizen could afford the essential services. With their differences and similarities, these systems of payment supplement and complement each other to ensure that healthcare in the United States is accessible to every individual regardless of their social or financial status.
Medicare, Medicaid, and Medicap Payment Systems
Medicare
Medicare is a government healthcare program which covers individuals who are 65 years or older, those with some disabilities, and those who have ALS or end-stage renal disease. The coverage is divided into four parts. Part A covers the hospitalization expenses, while part B deals with other services and equipment necessary for treatment. These include outpatient surgeries, wheelchairs, x-rays, lab work, and visits to doctor’s office. Part C is known as Medicare Advantage and is offered by private insurers, covering the aspects not addressed the regular plans such as dental and vision coverage. Part D is dedicated to prescription drug coverage, and like part C, payments are made out-of-pocket (Medicare, 2019). Medicare is therefore essential in ensuring that during the old age, payments during the working years would cater to the individual's healthcare.
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Medicaid
Medicaid is a program sponsored by the federal government, together with the state governments. Although its eligibility differs across different states, it is generally accessible to low-income citizens regardless of their age. Unlike Medicare, which has age restrictions, Medicaid is only limited by the level of income, aimed specifically at helping the poor. The services covered include; hospitalization, x-rays, laboratory services, family planning, doctor services, nursing and nursing facility services, clinic treatment, midwife services among many more (Lecture notes, n.d.). States are allowed to include additional benefits such as physical therapy, eyeglasses, medical transportation, and dental services (Advoken, 2009). One significant difference between Medicare and Medicaid apart from the age restriction is that Medicaid funds long-term care, which is not covered by Medicare and other private insurance companies.
Medigap
Medigap, also known as Medicare, supplements insurance by addressing the areas left out in Medicare such as coinsurance, copayments, and deductibles. When Medicare pays its approved amount, Medigap also pays its share. For one to be eligible for Medigap, they are required to have a Medicare policy (Cutler, Davis, & Stremikis, 2010). A major difference between Medigap and the other two healthcare payment plans is that while private insurance companies offer Medigap, Medicare and Medicaid are offered by the federal and state governments.
With the introduction of these programs, more people can access vital healthcare services when needed, reducing the health burden for individuals. Based on their personal and financial needs, individuals select the plan most suited for them and their families, ensuring major health issues do not financially overwhelm them. Medicare plan is also vital in helping individuals to access healthcare services after retirement, a time when numerous health challenges are likely to be encountered.
References
Advoken. (2009). Workers Compensation History. YouTube. Retrieved from https://www.youtube.com/watch?v=LHjTKPiZeJc&feature=youtu.be
Cutler, D., Davis, K., & Stremikis, K. (2010). The Impact of Health Reform on Health System Spending. Commonwealth Fund , 88(1405). Retrieved from https://d12yjkfv4xzz5l.cloudfront.net/uploads/e16c6bb0a28411e58070ab840edcfb25/original/1405_Cutler_impact_hlt_reform_on_hlt_sys_spending_ib_v4.pdf
Lecture notes. (n.d.). Introduction to Healthcare and Public Health in the US.
Medicare (2019). The Official U.S. Government Site for Medicare | Medicare. Retrieved 18 July 2019, from http://www.medicare.gov/
