Evaluation of Medicare and Medicaid Health Care Programs

This report provides a comprehensive overview of the Medicare and Medicaid health programs in the United States. It begins with an introduction to both programs, explaining their origins and purposes, followed by a detailed comparison of their key differences in terms of eligibility, coverage, and funding. The report then delves into the specific policies and plans of Medicare, including the different parts (A, B, C, and D) and the services they cover. Similarly, it outlines the policies and plans of Medicaid, discussing eligibility criteria and the services provided. The report also addresses the challenges faced by both programs, such as financial constraints and the impact of these challenges on patients. Finally, the report offers a conclusion summarizing the key findings and provides recommendations for improving healthcare services in America. This report is contributed by a student and is available on Desklib, a platform for AI-powered study tools.

Running Head: EVALUATION OF PUBLIC HEALTH CARE PLANS
0
Evaluation of Public Health Care Plans
Student details:

EVALUATION OF PUBLIC HEALTH CARE PLANS 1
Contents
Introduction......................................................................................................................................2
Introduction to Medicare and Medicaid..........................................................................................2
Distinction between plans of Medicare and Medicaid....................................................................2
Policy and Plans of Medicare.......................................................................................................2
Policy and Plans of Medicaid.......................................................................................................3
Challenges faced by Medicare and Medicaid and their impact over patients.................................4
Conclusion.......................................................................................................................................4
Bibliography....................................................................................................................................4

EVALUATION OF PUBLIC HEALTH CARE PLANS 2
Introduction
The following report constitutes the history of Medicare and Medicaid health program
initiated by the federal and state government of USA. The report also gives a brief about
difference between the working of both the programs, challenges faced by Medicare and
Medicaid and their effects over patients.
Introduction to Medicare and Medicaid
Medicare is a federal health insurance program which was developed in the year 1965 for
the people who are of or above the age of 65 years irrespective of their income, medical
conditions or health disorders. Medicaid is joint federal –state health insurance program which
provides coverage to nursing homes, people with low income level (includes children pregnant
women, people with disability and old age people). Both the programs have helped in
maintaining good health of people residing in America and increased their span of life. Medicare
and Medicaid have developed with time, it can be observed that Medicare changed the payment
structure by implementing capitation method and medicaid imposed some restrictions and
analytical criteria before providing aid to the patient. (Kff, 2019).
Distinction between plans of Medicare and Medicaid
Policy and Plans of Medicare
Medicare covers various health services including outpatient and inpatient hospital care,
prescription of drugs and physician services. It is divided into four parts; each part covers
different health care related costs.
 Part A covers Hospital insurance

EVALUATION OF PUBLIC HEALTH CARE PLANS 3
It includes the care while being in a hospital, medical services provided at home (in few
cases), SNF (skilled nursing facility) and hospice care.
 Part B covers Medical insurance
As the Part A only includes the matters related to hospital and patients, there was a
requirement of another plan which will include the fees of doctors, nurses and the cost incurred
over medical instruments and tools. (Buerhaus , Skinner, & Auerbach, 2017).
 Part C covers Medicare advantage
As per the balanced budget act of 1997 the patients can take health insurance which will
cover the private hospitals, here the insurer provides benefits to the patient not the government.
 Part D covers Prescription coverage
The people who are eligible for Part A and Part B are eligible for Part D, it is optional and
requires annual, monthly or quarterly premium it will be submitted to the private insurance
company and not to the government ( Rudowitz , Garfield, & Hinton, 2019).
Figure 1. Source: (Kff, 2019).
The figure depicts the payments made by
Medicare in the differ divisions.
Policy and Plans of Medicaid
Medicaid provides health insurance service
to the people with income level under a certain slab. The eligibility for getting medical aid by
medicaid recently got expanded. As per the Patient Protection and Affordable Care Act
(PPACA) ,all the citizens of USA (including the qualified non-citizens) with income up to 133%

EVALUATION OF PUBLIC HEALTH CARE PLANS 4
of the poverty line will be qualified for health coverage in any state which is a member of
Medicare program. This rule is not accepted by various states, they are functioning as per pre
ACA funding and eligibility standards.
Challenges faced by Medicare and Medicaid and their impact over patients
Less revenue and more expenditure-Medicaid in recent years have imposed some
restrictions over providing aid to the people suffering with hepatitis C, it is a contagious disease
and requires critical medical aid .Thus, the treatment becomes expensive due to which state and
federal government bear extreme expenditure over health(Liao & Fischer, 2017).This generates a
problem for the people who have low level of income as they cannot afford to take treatment on
their own. (Batsis, Huyck, & Bartels, 2015).
Conclusion
It can be concluded that both the plans have helped the people of America in getting
proper health care services. These plans have turn out to be very beneficial for the people with
low level of income. The government often faces burden of the expenditure made over the health
care issues, it is recommended that government should educate people regarding the activities
which are injurious to health. This will help in reducing the number of patients.
Bibliography
Rudowitz , R., Garfield, R., & Hinton, E. (2019). 10 Things to Know about Medicaid: Setting the
Facts Straight. Kff henry J kaiser family foundation.
Batsis, J. A., Huyck, K. L., & Bartels, S. J. (2015). Challenges with the Medicare obesity benefit:
practical concerns & proposed solutions. Journal of general internal medicine, 118-122.
Buerhaus , P. I., Skinner, L. E., & Auerbach, D. I. (2017). Four challenges facing the nursing
workforce in the United States. Journal of Nursing Regulation, 40-46.
Kff. (2019). An Overview of Medicare. Kff Henry J Kaiser Family Foundation.

EVALUATION OF PUBLIC HEALTH CARE PLANS 5
Liao, J. M., & Fischer, M. A. (2017). Restrictions of hepatitis C treatment for substance-using
medicaid patients: Cost versus ethics. American journal of public health, 893-899.