Medicare and Medicaid: Differences

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The American federal government supports such health care programs as Medicare, Medicaid, the Children’s Health Insurance Program, and the Veterans Health Administration. Medicare and Medicaid programs were signed in 1965 but they function differently.

Definition

Medicare is a federal program for medical insurance of senior Americans (65 and older) and some special categories of younger people. In comparison with younger adults seniors had to pay much more for their health insurance prior to the Medicare foundation. Medicare program is divided into two parts: A and B. Part A, hospital (hospice) insurance, mainly covers hospital stay and its costs. Part B (an optional part) is called medical insurance and includes services/products that are not covered by Part A.

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Medicaid is a program for medical insurance for all ages Americans with a low income funded not only by the federal but also a state government. Hence, each state has its own Medicaid program, which imposes some difficulties for its federal control because each state regulates eligibility, services, and payments. In addition, it is not obligatory for states to take part in the Medicaid program.

Eligibility

Accordingly, the eligibility for the Medicare program is based on age and federal stated disabilities. Medicaid program means-testing enrollees are defined by particular state regulations. To qualify for the Medicaid program, citizens must prove their low income. With reference to the Medicare program, United States citizens or legal residents (for over five years) after 65 years old are eligible for the program. Moreover, the program includes under 65 years old people with disabilities or specific medical conditions. Therefore, the system of eligibility for the Medicare program is clear and universal for all citizens of the United States. In contrast, the Medicaid program system of eligibility needs to be examined in each particular state. This imposes problems not only for citizens but also for health care providers and controlling agencies.

Funding

In respect to funding, the United States federal mandatory spending includes both Medicare program and Medicaid program, “the amount spent each year depends on how many people are eligible for Medicare program and Medicaid program, how many services are provided, what the federal government reimburses providers for those services, and how much beneficiaries must pay out of pocket” (Carpenter, 2011, p. 27).

Hence, it is not the same amount every year. Moreover, each state defines the funding of the Medicaid program in the corresponding state depending on the state budget. This adds difficulties for long-term health care programs for the particular enrollee.

In the matter of payments, some individuals receive both medical and non-medical services through the Medicaid program. However, “home healthcare is also being delivered in greater volume to those who are eligible for both Medicare and Medicaid or the dually eligible” (Sheehan, 2012, p. 319). Nevertheless, these individuals are “more likely than Medicare-only beneficiaries to use home healthcare services” (Sheehan, 2012, p. 319).

Services

The range of services covered by the Medicare program and Medicaid program differs. As to the Medicare program, it is the doctor’s responsibility to certify whether “intermittent skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services” (Sheehan, 2012, p. 319) is needed. For example, ninety days is the longest stay for Medicare Part A in a hospital. However, only the first sixty days are covered in full. As to the rest days, they should be co-paid.

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Nevertheless, Ng, Harrington, and Kitchener (2010) state that “Medicare provides short-term care after hospitalization to beneficiaries who are aged or disabled” but at the same time these categories “must require skilled care or therapy services for a short period” (p. 23). In addition, the Medicare program “covers hospice care at the end of life, in nursing homes, at home, or in residential settings” (Ng et al., 2010, p. 23).

In respect to the Medicaid program, all states are obliged to provide “nursing, home healthcare aides, medical supplies, and medical equipment” (Sheehan, 2012, p. 319). According to Ng et al., “three major state Medicaid home and community-based services programs are as follows: (1) waivers, (2) home health, and (3) personal care services” (p. 24). It allows every state to target different population groups; in addition, home and community-based services are offered only to the state eligible people. As to personal care, it can include help for shopping, eating, cleaning, and some other services. These services can vary in different states; therefore, each local Medicaid program can provide a wider range of services.

A qualitative research study

In 2009, F.E. Fox and colleagues, University of Bath, published their qualitative health research, “Experiencing “’the other side”: a study of empathy and empowerment in general practitioners who have been patients” (Qualitative Health Research, 2009).

The purpose of the study was to understand “interpretative perspective on GPs’ experiences of illness and the influence that this has had on their practice” (Qualitative Health Research, 2009).

The method used in the study was interpretative phenomenological analysis when seventeen GPs who “had experienced significant illness took part in semi-structured interviews” (Qualitative Health Research, 2009). Qualitative phenomenological research describes the “lived experience” of a phenomenon. Because it includes an analysis of narrative data, the method of analyzing the data is different from traditional or quantitative methods of research. The participants should describe their lived phenomenal experiences. Hence, the main tool to collect the description of the participants’ experience is an interview. The interview can be written or oral; a form of interviews can also vary from reports to poems.

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The conclusion of the study states that “work-related pressures and susceptibility to health problems mean that many general practitioners (GPs) will, at some stage, experience the role of patient” (Qualitative Health Research, 2009). The findings underline the relationship between empathy and empowerment and “explore the role of self-disclosure of GP status by GPs in consultations” (Qualitative Health Research, 2009). Moreover, Fox and colleagues “make suggestions as to how empathy in doctor-patient relationships can be developed through consideration of power and status as well as through interaction with patients from similar backgrounds. However, qualitative evidence about their experiences of illness and the patient hood is sparse” (Qualitative Health Research, 2009).

My choice of this qualitative research study is based not only on the fact of its immediate interest. In my opinion, future research in this field is essential for medical training. Moreover, I find phenomenological qualitative research more indicative for some cases where quantitative researches are not possible. The challenge of this type of research is, though, in trying to give instructions as non-directive as possible. It is essential to understand the meaning of a participant’s description. In a narrative analysis one must think of not only the description itself but also of the physical surroundings, take into consideration the characters or their relationship, be sure not to misinterpret data lacking the facts about the type of activity, specific descriptive elements, and time reference.

References

Carpenter, C. (2011). Medicare, Medicaid, and deficit reduction. Journal of Financial Service Professionals, 65(6), 27-30.

Ng, T., Harrington, C., & Kitchener, M. (2010). Medicare and Medicaid in long-term care. Health Affairs, 29(1), 22-28.

Qualitative Health Research; Reports outline qualitative health research study findings from University of Bath. (2009) Web.

Sheehan, K. (2012). Medicare and Medicaid: differing approaches to home health. Home Healthcare Nurse, 30(5), 319-320.

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NursingBird. (2022, May 30). Medicare and Medicaid: Differences. Retrieved from https://nursingbird.com/medicare-and-medicaid-differences/

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NursingBird. (2022, May 30). Medicare and Medicaid: Differences. https://nursingbird.com/medicare-and-medicaid-differences/

Work Cited

"Medicare and Medicaid: Differences." NursingBird, 30 May 2022, nursingbird.com/medicare-and-medicaid-differences/.

References

NursingBird. (2022) 'Medicare and Medicaid: Differences'. 30 May.

References

NursingBird. 2022. "Medicare and Medicaid: Differences." May 30, 2022. https://nursingbird.com/medicare-and-medicaid-differences/.

1. NursingBird. "Medicare and Medicaid: Differences." May 30, 2022. https://nursingbird.com/medicare-and-medicaid-differences/.


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NursingBird. "Medicare and Medicaid: Differences." May 30, 2022. https://nursingbird.com/medicare-and-medicaid-differences/.