Medicaid and Medicare
Medicaid and Medicare are two health programs that sound very similar and usually confused and used interchangeably despite being very different. Each of these government health insurance programs is regulated by a set of its own policies and laws (Mitchell, Potter & Amin, 2019). In addition, the programs differ on the premise that they designed for different sets of individuals. Medicare is a federal health insurance program that serves people aged 65 years or more or those under 65 years and have a disability. This program provides health insurance coverage to these individuals regardless of their incomes. Medical bills under this program are paid from trust funds paid into by those covered (Digital Communications Division, 2015). As a federal program, Medicare is primarily similar across the country and run by the Centers for Medicare & Medicaid Services. On the contrary, Medicaid is an assistance program that serves low-income individuals of every age. This program is run by state and local governments based on federal guidelines and differs across states. While a small co-payment is required in some instances, patients always pay no part of the costs for covered healthcare expenses.
Since the 1990s, states have actively expanded their Medicaid...
…current Medicaid populations. Health maintenance organizations (HMOs) are the most commonly used managed care arrangements. As a result, Medicaid enrollment in HMOs has continued to grow since 2002 (Draper, Hurley & Short, 2004). Despite the growth in total enrollment in HMOs nationally, enrollment has decreased each subsequent year since it peaked in 1999. This is an indicator of the difficulty in enrolling all of the Medicaid population in HMOs. It would be difficult to enroll all of the Medicaid population in HMOs because of the decline in flush state budgets funding, cost reduction measures for Medicaid programs by states, and reduction…
References
Digital Communications Division. (2015, October 2). What is the Difference Between Medicare and Medicaid? Retrieved from U.S. Department of Health and Human Services website: https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html
Draper, D.A., Hurley, R.E. & Short, A.C. (2004, March 1). Medicaid Managed Care: The Last Bastion of the HMO? Health Affairs, 23(2), 155-167. Retrieved from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.23.2.155 Mitchell, J., Potter, D. & Amin, S. (2019, December 10). Medicare vs. Medicaid. Retrieved November 10, 2020, from https://www.healthline.com/health/medicare/medicare-vs-medicaid
Medicaid has long been an issue of debate throughout the country. Healthcare is a critical need and many Americans do not have any healthcare. Therefore, Medicaid is vitally important because it provides healthcare to the poor. For many years, both federal and state governments have attempted to reduce the cost associated with Medicare. Some states have resorted to allowing HMO's to take responsibility for some of the recipients of Medicaid.
Medicaid Health Care Assistance How does the organization fund its programs? Medicaid was developed for the sole purpose of providing health care services to low income individuals and families. For those people that cannot afford to pay for these services, the program makes it possible for you to get the treatment you need when obtaining them is challenging (based upon financial considerations). To qualify for this entitlement program there are a number
Medicaid and Medicare Fraud Describe health news story combating health care fraud Medicare Medicaid• Examine evaluate corporate structure governance, culture, focus social responsibility • Recommends Medicare and Medicaid fraud: An overview Medicare and Medicaid fraud: An overview While there is still little consensus regarding the best ways to go about enacting healthcare reform, one issue that unites both Democrats and Republicans is the need to eliminate Medicaid and Medicare waste, fraud and abuse. According
Medicare.gov/MedicareEligibility/home.asp?version= default&bro wser=IE%7C7%7CWindows+Vista&language=English and following the prompts to enter personal information that will serve to assist the establishment of eligibility for Medicare. Generally, one is eligible for Medicare if they or their spouse "worked for at least 10 years in Medicare-covered employment" and if the individual is at least 65 years of age or order and is a permanent resident of the United States. IV. Medicare Premiums One qualifies for Medicare Part
5 billion in unpaid medical claims from 2005-2007 and there was a total of $80.6 million in unpaid interest owed to providers treating Medicaid patients between July 1999 and November 2007, despite the existence of an Illinois prompt-payment law. This interest is money that should not 'need' to have been spent, since money paid for interest does nothing to improve the quality of care for recipients. Another problem is a
Fraudulent activities such as these resulted in violations under the act, including a fine of not more than $25,000.00 or imprisonment for not more than five years, or both. Analysis of Current Fraud legal analysis of the current fraud committed in the Medicare and Medicaid programs indicates that reforms are in place to detect this fraud, and the involvement of governmental, local and federal police and investigation authorities has increased
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