Compare and Contrast Medicaid and Medicare

1 January 2017

They are social insurance programs, which allow the financial load of patient’s illnesses to be shared by other healthy, sick, wealthy, and lower income individuals and families. Medicaid Medicaid insurance covers approximately 60 million Americans, according to their income. Medicaid is larger than any other single private health insurance program. The criteria for participating would include those who are unable to work due to disabilities, anyone who receives Aid to Families with Dependent Children (AFDC), as well as single, pregnant women who fall below the Federal Poverty Level (FPL).

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In 2011, the FPL for a family of four was set at $22,350. This amount is updated yearly. Medicaid also helps those who are part of the Supplemental Social Security Income (SSI) program (Mann, 2012). Funding for Medicaid comes from the government as well as each state’s department of SSI. They are also responsible for administering funds. Medicare Medicare is a federal government program that offers individual health care insurance to those who are 65 or older, and/or have a disability, no matter what their income level. Taxes that are deducted from one’s payroll helps pay for the Medicare program. The Medicare program has four parts; Parts A,

B, C, and D. Part A is the original program for hospitalization and requires no monthly premium to be paid. Some physicians do not accept Medicare patients because of low payout rates, longer reimbursement time, and limitations put on physicians for the way they are allowed to perform procedures. Other reasons are that many claims are denied and there is too much paperwork involved (Vineyard, 2010). IMPACT ON HEALTHCARE PROFESSIONALS One of the main issues affecting healthcare professionals is the challenge these programs have in finding physicians who are willing to treat patients who are covered by Medicaid or Medicare.

The reimbursement rates are generally very low, and each program actually pays out differently; Medicaid doctors are only paid 66% of what Medicare doctors are paid for primary care. In the United States, doctors are not required to accept Medicaid patients, and many refuse to do so. Only 40% of physicians accepted new Medicaid patients in 2008 (Results. org, n. d. ). Not every physician accepts Medicaid patients; some states have been reducing funds for the program for years. In a study in 2009, they studied the errors caused by lack of efficiency, unwarranted use, procedures that were avoidable, and fraud and abuse.

They discovered that about a third ($700 billion) of the annual health care spending as a whole was wasteful. Instead of trying to fix that problem, many states just cut money out of the Medicaid program (Siegel, 2011). Medicaid patients have fewer options for medical care compared to those with private insurance plans. One of the main challenges for physicians treating Medicaid patients is their difficulty in referring patients, especially children, to specialists. The reimbursement issues also cause many physicians to opt out of accepting Medicaid patients.

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