Medicare is a healthcare program that was passed under the 1965 Social Security Act, and it provides care for citizens 65 years and older or even those with a debilitating illness. Medical necessity, often dictates whether one gets cover or does not. The necessity is commonly prescribed by the federal or national regulations as well as local coverage decision.
Medicare program is divided into four sections. The first components are usually mostly confined to inpatient services (Edmunds, Sloan, Steinwald and CGAF, 2012). The coverage here may be extended to overnight stays. It ranges from urgent medical concerns to hospice care and other possible extended visits in either a hospital or a nursing home. There is restriction here, though, if the patient is to go for an identical procedure within 30 days, Medicare will not cover it.
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The second part covers medical insurance for services and procedures not covered under the first part. This part takes care of physician services like x-rays as well as nursing care. It also gives cover to durable medical equipment like walking cane. The fist and the second parts are the basic tenets of Medicare.
The third part of this program is also known as the Advantage plan, and it allows subscribers to receive their coverage in its entirety through a private organization. Subscription to the third part does not require one to subscribe to the first and the second parts.
Medicaid, on the other hand, is jointly fronted by both State and Federal governments. It provides healthcare for individuals who might not be able to afford them at the end of the day. It covers low-income families, the elderly, as well as persons with disability (Baylis, 2010). Unlike its Medicare counterpart, the regulations given to Medicaid vary from state to state. However, each state still has to meet specific standards set by the federal government.
Medicaid covers seven essential services. Some of those services are Family planning care, prescription drug costs, pediatric services, as well as inpatient outpatient services. Person eligibility in Medicaid varies from one state to another. However, there are some standard baselines when it comes to criteria for coverage. Some of these are that it covers individuals suffering from specific chronic disabilities. It also allows overage for those who are social security beneficiaries (Wannisky, USGAO and CMMS, 2002). Also allowed coverage are adults with children that earn less than a certain level of income even though this provision varies from state to state and depends on the number of children.
References
Baylis, C. (2010). Medicare advantage : The alternate Medicare program (Public health in the 21st century series). New York: Nova Science. (2010). Retrieved September 22, 2019, from WorldCat.org.
Edmunds, M., Sloan, F., Steinwald, B., & Institute of Medicine (U.S.). Committee on Geographic Adjustment Factors in Medicare Payment. (2012). Geographic adjustment in medicare payment (Vol. Phase 2, implications for access, quality, and efficiency /). Washington, D.C.: National Academies Press. (2012). Retrieved September 22, 2019, from WorldCat.org.
Wannisky, K., United States. General Accounting Office, & Centers for Medicare & Medicaid Services (U.S.). (2002). Department of Health and Human Services, centers for Medicare and Medicaid services: Medicare program: Prospective payment system and consolidated billing for skilled nursing facilities--update, notice . Washington, DC: U.S. General Accounting Office. (2002). Retrieved September 22, 2019, from WorldCat.org.
