The Medicare and Medicaid Programs

The Medicare and Medicaid programs are insurance initiatives that were established with a view of meeting the health needs of the United States population. However, the two programs have significant differences that will be discussed in this section. At the outset, the medical bills in Medicare are usually paid by trust funds. The Medicare program covers over 65-percent of the patients’ medical bills regardless of their income levels and health statuses. Many insurance firms have reported that the Medicare program currently indemnifies people with chronic diseases such as cancer and HIV/AIDS. In addition, patients are allowed to pay a part of the costs in an organized deduction for hospital and other health costs. Patients will are also asked to pay small monthly premiums in a non-hospital situation (Henshaw, Joyce, Dennis, Finer, & Blanchard, 2009). The federal government initiated the Medicare program in the United States. The initiative has remained consistent in almost all the states of the US under the control of the centers for Medicare and Medicaid Services.

Although many beneficiaries in the United States have embraced the Medicare service for more than 10 years, the rating is gradually dropping with the introduction of Medicaid health insurance. There are often questions regarding access to quality healthcare in the US. This situation is evident where patients experience chronic illnesses. However, there have been reforms to improve the ratings over time. According to Noble, Biller-Andorno, Sutherland, & Anstey (2013), sick beneficiaries in the Medicare support have always rated their plans lower as compared to those of other health insurance programs. In addition, Furlow (2014) found that there was a lower care rating amongst the most vulnerable groups such as the elderly people living with HIV and other forms of chronic illnesses.

On the other hand, the Medicaid initiative plays a significant role as an assistance program. Unlike the Medicare program, Medicaid allows patients who do not have to pay premiums to access healthcare. However, a small co-payment is required at times depending on the kind and frequency of treatment. The Medicaid program was designed by the US government to serve the low-income group regardless of age (Henshaw et al., 2009). It is a common trend that a patient who qualifies for Medicaid does not pay any part of the cost to cover their medical expenses. This is a federal-state program; hence, it is conducted differently in each state, unlike the Medicare program that adopts a universal system. The state and local governments also manage the Medicaid insurance initiative under the guidelines proposed by the federal government. However, one should note that Medicaid does not pay the beneficiary for any treatment as it sends the compensation directly to the healthcare provider. With regard to the state rules, people are often asked to pay a small part of the cost. This cost is usually referred to as a co-payment for some of the services.

Unlike the Medicare health insurance program, Medicaid has often faced a lot of controversy since its inauguration. According to Henshaw et al. (2009), the issue of readmission has often hindered the impact of Medicaid on societies. Patients who have benefited from the Medicaid program are likely to face challenges due to their social and economic statuses.

Whether a person chooses to undertake either the Medicare or Medicaid program, it is important to weigh all the options with regard to specific medical needs. For example, the Medicaid program seems to have a challenge with reference to the patients with mental health and substance abuse issues. Such groups highly utilize the Medicaid program. Other challenges include the defaulting of medical instructions, readmission, and exposure to risky environments after the patient has been discharged from the healthcare facilities (Noble et al., 2013). For patients under the Medicare program, the biggest challenge faces the beneficiaries with chronic illnesses in cases where they are required to pay a premium fee to access the healthcare insurance. If one fails to comply with this guideline, there is a high possibility of discontinuing the treatment until the compliance is realized by the hospital.

Reference List

Furlow, B. (2014). Cuts to US Medicare disrupt chemotherapy services. The Lancet Oncology, 6(14), 456-459.

Henshaw, S., Joyce, T., Dennis, A., Finer, L., & Blanchard, K. (2009). Restrictions on Medicaid Funding for Abortions:A Literature Review. New York, NY: Guttmacher Institute.

Noble, D., Biller-Andorno, N., Sutherland, J., & Anstey, M. (2013). Challenges facing Medicaid expansion in the US. Web.

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NursingBird. "The Medicare and Medicaid Programs." April 27, 2022.