A Detailed Report on Medicare and Medicaid Programs and Their Impacts

This report provides a comprehensive overview of Medicare and Medicaid, two crucial healthcare programs in the United States. It begins by defining Medicare as a federal insurance program primarily for individuals over 65, and Medicaid as a state-federal program assisting low-income individuals. The report delves into the effects of Medicare on medical billing, highlighting its role as a primary payer and the potential for billing fraud. It then outlines the qualifications for both Medicare and Medicaid benefits, including age, income, and work history requirements. Furthermore, the report explores the impacts of the Affordable Care Act (ACA) on Medicare and Medicaid recipients, discussing cost reductions, benefit enhancements, and expansions in eligibility. The analysis includes a discussion of how the ACA has influenced program registration and access to healthcare services. The report concludes by summarizing the key findings and emphasizing the significance of these programs in the broader healthcare landscape.

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MEDICARE AND MEDICAID
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5/25/2019

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Table of Contents
Introduction.................................................................................................................................................2
Effects of Medicare on medical billing....................................................................................................2
Qualifications for Medicare and Medicaid benefits.................................................................................3
Impacts of ACA on Medicare recipients..................................................................................................4
Impacts of ACA in Medicaid...................................................................................................................4
Conclusion...................................................................................................................................................5
References...................................................................................................................................................6

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Introduction
Medicare is the assurance program. Medicinal bills are compensated from trust resources
which those enclosed have compensated into. It assists individuals over 65 principally, whatever
their revenue; and obliges younger incapacitated individuals and dialysis patients. Diseased
persons pay a share of prices through the deductibles for clinic and other charges. Minor monthly
payments are obligatory for the non-hospital coverage (Kluender, & Mast, 2017). Medicaid is the
support program. It assists low-income individuals of all ages. Patients commonly pay no share
of prices for covered medicinal expenditures. A minor co-payment is occasionally necessary.
Medicaid is the federal-state initiated program (Alley, Asomugha, Conway, & Sanghavi, 2016).
In this specific assessment, the effect of Medicare on medical billing, qualification for Medicare
and Medicaid benefits, and the impact of ACA on Medicare and Medicaid recipients will be
discussed.
Effects of Medicare on medical billing
Medicare serves as the solitary spender healthcare scheme that pays assurance
administration in half of the persons registered in its several programs. Medicare Part D initiative
involves Medical coding and billing which is the occupation of billers who serves pharmacies
that assist outpatients. Another program, Medicare portion a converts the charges for inpatient
upkeep in the clinics, expert nursing facilities, and home wellbeing care (Silver, Rahman,
Wright, Besdine, Gozalo, & Mor, 2018). Medicare program for all types of bills commands main
payment discounts for America's wellbeing care staff. Part b of Medicare help to pay for
services supposed clinically important. These amenities include doctor services, outpatient’s
appointments, robust health devices, and household wellbeing services. The capability to spread

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wrong billings amongst numerous insurers concurrently, counting public programs, for example,
Medicare and Medicaid, cumulative fraud profits while decreasing their probabilities of being
noticed by any a sole insurer (Simpson et al., 2018). It can also be used to reduce patient co-pays
or as deductibles for the bills medicinal or dental upkeep and over-billing the assurance carrier or
advantage plan (Silver et al., 2018).
Qualifications for Medicare and Medicaid benefits
Medicare is the federal initiative that delivers fitness coverage if the patient is above 65
years old or less than 65 and has incapacity, without considering their incomes. This particular
program also delivers health coverage if the patient has a very low salary or revenue. In order to
qualify for the Medicare Part A which is premium-free, patients and their families require to
have a minimum of ten years of experience and remunerated Medicare workforce taxes while
functioning. Medicare Fragment B has a quality that most individuals pay. To cover extra
charges or deliver additional health-care facilities, the person might register into the Medicare
Prescription Drug Plan (Part D) or the Medicare Advantage plan (Part C) (Harper, Nasis, &
Sundararajan, 2015).
Eligibility for the Medicaid is actually means-based, and the government program has
stringent revenue eligibility necessities that differ in every state. The program set some
qualification criteria according to The Affordable Care Act which prolonged Medicaid eligibility
standards in certain states started on 1st January 2014. If an individual is qualified for both
Medicare and Medicaid programs (dually eligible), then he or she can have both (Handley,
2019). Both the programs that provide the individual with wellbeing coverage and lesser charges.
Double eligible recipients” commonly define beneficiaries qualified for both programs of

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Medicare and Medicaid. The word includes recipients registered in Medicare Portion A, Portion
B, or both and getting complete Medicaid welfares or support with Medicare rewards or cost
distribution by one of these Medicare Savings Program (MSP) qualified groups (Cuomo,
Sullivan, & Gonzalez-Sanchez, 2015). Qualified Medicare Beneficiary (QMB) Program: This
particular program aids pay dividends, some deductibles, all coinsurance, and the co-payments
for Fragment A, Fragment B, or both type of programs, Specified Low-Income Medicare
Beneficiary (SLMB) Program: this program Supports pay Part B premiums. Qualifying
Individual (QI) Program: Benefits pay Fragment B payments. Qualified Disabled Working
Individual (QDWI) Program: Wages the Fragment A premium for some incapacitated and
working recipients who have incapacities (Castillo, Pincus, Smith, Miller, & Fish, 2017).
Impacts of ACA on Medicare recipients
The ACA is progressively reducing costs by rearranging expenditures to Medicare
Advantage, Once the ACA was legislated, there were prospects that Medicare Advantage
registration would fall as the payment reductions would activate benefit discounts and premium
upsurges that would direct enrollees away from the Medicare Advantage strategies (Henke, et al.,
2018). The ACA- encouraged MA expense alterations abridged the sum of strategy selections
obtainable for Medicare recipients; however, they have yet exaggerated registration patterns.
The ACA comprised provisions to advance Medicare welfares by delivering free attention for
certain preventive welfares, for example, screenings for the breast and colorectal malignancy,
cardiovascular illness, and diabetes and terminating the coverage hole (Remler, Korenman, &
Hyson, 2017).

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Impacts of ACA in Medicaid
Generally, the statistics propose that the Affordable care act is partaking an encouraging
effect on Medicaid and CHIP registration, principally in states that obligate applied the Medicaid
expansion. Though, it remains puzzling to quantify and distinctly classify the influences of the
particular ACA guidelines on registration (Graves, & Swartz, 2017). The Affordable care act
enlarges Medicaid suitability to grown-ups with earnings at or underneath 138 per cent of the
poverty level that is just over $16,000 each year for a person currently. The Affordable care act
sorts it easier for individuals to register in and reintroduce coverage of Medicaid. Earlier to the
Affordable care act states had attained varied development in updating and simplifying their
Medicaid registration procedures. The ACA encouraged outreach and registration efforts to
support connect qualified publics to coverage. Composed, these three important alterations are
predicted to lead to augmented Medicaid coverage and a decrease in the sum of uninsured (Hyde,
Anand, Colby, Hula, & O’Leary, 2017).
Conclusion
Medicare is the insurance program that has been started by the government, which serves
people aged 65 or above, and some disabled people. On the other hand, Medicaid serves low-
income individuals for non-hospital coverage. Medicare has both positive and negative impacts
on billing such payment reduction, covering all facility in one bill, and fraud billing issues. To be
Qualified for Medicare and Medicaid one must have 10 years or more experience, and restricted
income levels. ACA impacts on Medicare and Medicaid include reduced payment, improved
Medicare benefits, expands the Medicaid eligibility, and encouraged outreach a membership
efforts

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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.
Castillo, E. G., Pincus, H. A., Smith, T. E., Miller, G., & Fish, D. G. (2017). New York state
Medicaid reforms: opportunities and challenges to improve the health of those with serious
mental illness. Journal of health care for the poor and underserved, 28(3), 839-852.
CUOMO, A. M., SULLIVAN, A. M. T., & GONZALEZ-SANCHEZ, M. A. (2015). New York
Request for Qualifications for Adult Behavioral Health Benefit Administration.
Graves, J. A., & Swartz, K. (2017). Effects of affordable care act marketplaces and Medicaid
eligibility expansion on access to cancer care. Cancer journal (Sudbury, Mass.), 23(3),
168.
Handley, M. (2019). Qualified: Medicaid Provider Agreements, Waivers, and the Politics of
Planned Parenthood. Health L. & Pol'y Brief, 13, 29.
Harper, R. W., Nasis, A., & Sundararajan, V. (2015). How changes to the Medicare Benefits
Schedule could improve the practice of cardiology and save taxpayer money. The Medical
Journal of Australia, 203(6), 256-258.
Henke, R. M., Karaca, Z., Gibson, T. B., Cutler, E., White, C., & Wong, H. S. (2018). Medicare
advantage penetration and hospital costs before and after the Affordable Care Act. Medical
care, 56(4), 321-328.

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Hyde, J. S., Anand, P., Colby, M., Hula, L., & O’Leary, P. (2017). The Impact of Affordable
Care Act Medicaid Expansions on Applications to Federal Disability
Programs. Mathematica Disability Research Consortium Working Paper, 1, 2017.
Kluender, R., & Mast, E. (2017). Information Frictions & Insurer Plan Design: Evidence from
Medicare Advantage. Available at SSRN 2705863.
Remler, D. K., Korenman, S. D., & Hyson, R. T. (2017). Estimating the effects of health
insurance and other social programs on poverty under the Affordable Care Act. Health
Affairs, 36(10), 1828-1837.
Silver, B. C., Rahman, M., Wright, B., Besdine, R., Gozalo, P., & Mor, V. (2018). Effects of
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Simpson, K. N., Seamon, B. A., Hand, B. N., Roldan, C. O., Taber, D. J., Moran, W. P., &
Simpson, A. N. (2018). Effect of frailty on resource use and cost for Medicare
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