Medicaid and Medicare Services

Medicaid and Medicare Services

Medicaid is a federal-state-funded healthcare plan for poor individuals and families, including families with children, pregnant women, and disabled persons. Every year, Medicaid participants must go through a reevaluation process to see if they are still eligible (Compare, 2015). While on a Medicaid plan, individuals and families must disclose any changes in yearly salary. On the other hand, Medicare is a government-financed scheme that insures persons above 65 years, disabled persons under 65 years, and those with End-Stage Renal Disease. When an individual or their partner works and pays Medicare taxes for at least ten years, they are entitled to premium-free Part A Medicare insurance at age 65.

Population under Medicare

Individuals aged 65 and above,

Persons with disabilities and are under age 65,

People with end-stage renal diseases, including permanent kidney failure patients on dialysis or those requiring a kidney transplant.

Medicare Services

Medicare Part A (Hospital Insurance)

The individuals under hospital insurance do not pay any medical insurance fee. The person applying or their spouse must have paid the coverage while on service. It covers inpatient hospital care, provision of skilled and special nursing services, laboratory tests ordered, surgeries performed, and home-based health care. The care is not guaranteed, as beneficiaries must meet these particular conditions.

Medicare Part B (Medical Insurance)

Part B contributes to the cost of doctor’s consultations and outpatient care. It covers specific medical treatments not included in Part A services, including some occupational and physical therapy services and some home health care services (Cubanski, Neuman & Freed, 2018). In addition, Part B helps pay for these services when they are approved and medically required. For this cover, the majority of patients pay a monthly fee.

Medicare Part D (Prescription Drug Coverage)

The coverage is available for anyone on Medicare services. It requires a monthly premium payment. Therefore, any individual interested in the coverage must join the plan and make the monthly payment.

Long Term Care

Skillful Nursing Facilities

The facilities are provided by registered nurses, physical therapists, and other professionals who provide medical services from a professional view to monitor, manage and treat a health condition. Eligibility includes inpatient and documentation from the doctor stating the requirement for daily monitoring.

Hospice Care

This service involves the provision of care for terminally ill patients. It aims at managing the symptoms and providing support. For eligibility for the cover, the patient must be terminally ill and must accept to have palliative care over forms of treatment plans.

Medicaid

The population covered by the Medicaid plan are low-income families, pregnant women and children, children in foster care, and those on supplemental security income (Compare, 2015). The program also covers individuals receiving home and community-based care, though not guaranteed.

Services

Services provided by Medicaid are both inpatient and outpatient services, laboratory test services, physician services, and home-based care services. Accordingly, inpatient services may include close monitoring by skilful nursing facilities and any tests done. X-ray services are among the services offered by the plan. On the other hand, home-based care services include palliative care, recovery care, and nursing charges. The insured individual does not pay a monthly fee, as the state and federal governments jointly pay the fee.

Long Term Care

Long-term care involves providing nursing home services to aged and terminally ill patients. Adult daycare, where adults are enrolled, provides essential care services (Thach & Wiener, 2018). The adult care facility is located within the community, where all the families can access and transport their aged family members daily. In-home services are another long-term care provided under Medicaid. The chronically ill patients and the aged may consider the insurance program to allow home-based care. There are several restrictions to Medicaid services, and before one is guaranteed coverage, the individual’s financial capability is determined. One must be pregnant and a low-income earner to receive the cover.

 References

Compare, N. H. (2015). The Centers for Medicare and Medicaid Services. The Centers for Medicare and Medicaid Services

Cubanski, J., Neuman, T., & Freed, M. (2018). The facts on Medicare spending and financing. Washington, DC: Kaiser Family Foundation.

Thach, N. T., & Wiener, J. M. (2018). An overview of long-term services and supports and Medicaid. Final Report to the Office of the Assistant Secretary for Planning and Evaluation. TinyURL. com/yyfs2fv9. Retrieved July 15, 2019.

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The federal and state governments are the largest payers of health care services in the United States. The most extensive federal programs are Medicare and Medicaid.

Medicaid and Medicare Services

Using the information from the textbooks, lectures, and Internet resources, summarise Medicare and Medicaid services in a Microsoft Word document. To get up-to-date information on the programs, review the information shared on the following websites:

The Centers for Medicare and Medicaid Services
The Social Security Administration
In your summary, include the following points:

An overview of the different Medicare and Medicaid services
The population covered under Medicare and Medicaid services
The services of long-term care covered under Medicare and Medicaid, including the restrictions placed on them
To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.