Medicare and Medicaid are health insurance programs provided by the government in a cost-sharing bid to reduce the burden for citizens. However, these programs are run differently and include different populations being covered under varying circumstances. The two insurance programs also vary in terms of who runs them and how they benefit citizens of the US. Most important is the aim to cover the vulnerable in society by both programs. While both Medicare and Medicaid target the vulnerable with subsidized and free medical services, a lot of citizens who may need coverage are often left out.
Both Medicaid and Medicare target the vulnerable in society for coverage and provides free services to those in need. While Medicare and Medicaid are separately run government programs, they include services that are related in terms of the beneficiaries. Medicare is a program run by the federal government that provides healthcare coverage for people of 65 years and above, and those with disabilities irrespective of their income ( Alley et al., 2016). Medicare hence covers payment for the elderly’s medical bills ensuring that they receive vital healthcare services. For people under the age of 65 years covered by Medicare, they qualify for Medicare cover if they have a disability. On the other hand, Medicaid is a program run by state and federal governments that provide health coverage to low-income earners (Sklar & Zuraw, 2019) . The two programs work hand-in-hand to lower healthcare costs for US citizens.
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Qualifications to Receive Medicaid
While the two covers seem straightforward, there are hurdles that one meets to receive the full rights to coverage. Medicare is divided into Part A that includes hospital insurance and B called Medicare insurance. To be eligible for Part A, one must be aged at least 65 years or have a spouse who paid Medicare taxes while working at least ten years ( Alley et al., 2016) . However, those who are receiving social security benefits or retirements from Railroad Retirement Board; those with a spouse who had government employment that was covered by Medicare; and those eligible for railroad benefits and social security benefits (Sklar & Zuraw, 2019) . One is also covered by Medicare if they are under kidney dialysis or have undergone a kidney transplant. Finally, Medicare covers all access to prescription medicine regardless of income, health status, age, or any other factor to those with the service.
Those who do not qualify for Medicare coverage and based on these criteria have to pay monthly charges to get services from the program. To get hospital insurance, an individual who is 65 years and more pays a premium based on their credits (Nickitas et al., 2016) . They, however, must pay for seeing the doctor and outpatient services. However, some people opt to buy part B without taking hospital insurance.
While Medicaid has made the lives of the vulnerable bearable by covering most of their healthcare bills, a lot of helpless Americans still run uncovered. Health inequality in the country has called attention to the relevance of Medicaid in reducing the healthcare burden for the vulnerable, mainly because most are revealed (Sklar & Zuraw, 2019) . With research indicating additional people, including children being left out of health insurance due to challenges paying for premium Medicaid, there is an apparent need to increase coverage for health insurance. Different researchers have proposed methods to increase the coverage of Medicaid and protect vulnerable populations from the consequences of improved.
Modifying Medicare and Medicaid to reach Vulnerable Populations
Two broad strategies can be used to increase the coverage for the vulnerable by the Medicaid scheme. The first strategy involves efforts to improve the quality of the Medicaid program. These include such measures as an improvement on the criteria used for determining eligibility, changes on the premium and those on delivery of healthcare. The second strategy involves outreach strategies to improve the reach of insurance schemes. Efforts to increase the enrolment of more vulnerable people to the Medicaid scheme, making changes in the recruitment and improvement in management fall under this category.
Changes in the Program Design
The first strategy for change in the design of the Medicaid and Medicare program is making changes in the eligibility criteria. There should be efforts to create more uninsured persons eligible for medical insurance. With the possibility of universal healthcare having been delayed in the US, the government should increase the already existent structures to include more people. In California, the poverty expansion program has seen more children be enrolled in the Medicaid scheme (Nickitas et al., 2016) . Such measures as those in California where the expansion of Poverty programs has seen children be covered fall under this category. Other applications should target vulnerable groups, including the unemployed in the country.
The second measure under the design of the health insurance schemes is changing to make premium affordable. According to ( Thornton et al., 2016) , most Americans consider health insurance too expensive to be accommodated by their current incomes. The government should use subsidies and create suitable premium so that a majority of eligible populations can afford. For example, in the Philippines, local governments share the cost of the national health insurance program by subsidizing indigent households (de Andrade et al., 2015) . Reducing premiums will encourage more people to acquire insurance.
Under the design strategies, the government can also improve the processes involved in healthcare delivery. The government ought to take control of the healthcare sector, including the quality and price of services offered (Nickitas et al., 2016) . Also, the Medicaid insurance program must include additional services provided to make it lucrative to people. Including other services that can be provided through the insurance, the scheme will increase coverage and its effectiveness in responding to healthcare needs.
Strategies to improve program implementation
In policy for the implementation of the programs, there is a need for increasing awareness of medical insurance schemes. Proper distribution of information about Medicaid, including its benefits is a vital step towards increasing coverage. While there is information on Medical insurance schemes in the US public domain, Sklar & Zuraw, R. (2019) notes that poor targeting makes it not to reach most people. Using the means most close to the targeted people is hence, vital to achieving and creating awareness.
The second method in this area is the modification of the enrollment protocol. There are a lot of factors and considerations that one must fulfill to get both Medicaid and Medicare covers. The simplification of enrollment procedures and reducing the requirements for eligibility will go a long way to improve enrollment. For example, in California, the government works with community-based organizations to reach out to families that are potentially eligible for Medicaid. In Florida, the school lunch program is used to identify families where health insurance and state subsidies are required hence make it easier to administer.
Finally, there is a need for the improvement of the management of the health insurance schemes to make them useful in reaching the vulnerable. Improved training, use of quality information systems, and effective programs for outreach are needed for proper coordination of the programs. This will ensure support of the programs from top to bottom. Also, having insurance staff in a community who are trained to assess and identify vulnerable populations would work great in reducing low coverage.
References
Alley, D. E., Asomugha, C. N., Conway, P. H., & Sanghavi, D. M. (2016). Accountable health communities—addressing social needs through Medicare and Medicaid. N Engl J Med , 374 (1), 8-11.
De Andrade, L. O. M., Pellegrini Filho, A., Solar, O., Rígoli, F., de Salazar, L. M., Serrate, P. C. F., ... & Atun, R. (2015). Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. The Lancet , 385 (9975), 1343-1351.
Nickitas, D.M., Middaugh, D.J., & Aries, N. (2016). Policy and Politics for nurses and other health professions ( 2nd ED)
Sklar, T., & Zuraw, R. (2019). Preparing to Age in Place: The Role of Medicaid Waivers in Elder Abuse Prevention. Annals of Health Law , 18-34.
Thornton, R. L., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs , 35 (8), 1416-1423.
