Introduction
The two types of healthcare system in the United States are Medicare and Medicaid. These two are however very different. Nevertheless, a person can qualify and also receive coverage for both healthcare systems. However, one needs to meet different requirements so as to be eligible for each program. Being qualified for one program does not mean that one is qualified for the other.
Medicare
The Medicare healthcare system was created with the purpose of dealing with the high medical costs which are faced by the elderly citizens in comparison with the rest of the population. It focuses on the elderly more so because they have a reduced earning power. Nevertheless, access to Medicare is not limited to the individual's need. It is more of an entitlement program whereby one is entitled to it because that person or the spouse paid for the Medicare system through the Social Security Taxes.
The Medicare system covers people who are above the age of sixty-five. In addition to that, the system covers some individuals with End Stage Renal Disease (permanent kidney failure) that require a transplant or dialysis and some with Social Security disability (Medicare, 2016).
The system has four parts covering different scopes. Part A covers hospital care, care in a highly skilled nursing facility, inpatient hospital stays and also several home healthcare. Part B, on the other hand, covers doctor's services, medical supplies, outpatient care and preventive services. Part C is specifically offered to a private company. The company contracts with the health care system to provide them with the coverage of both Part A and B benefits (Medicare, 2016). These benefits include a private fee for service plans, Medicare medical savings account plans, and healthcare maintenance organizations. Finally, part D adds the benefit of prescription drug coverage to the original contract in part C.
Medicare is a federal program which similar nationwide. It is paid through two trust funds accounts which are held by the Treasury of the United States. The first source is the Hospital Insurance Trust Fund (Medicare, 2016). These funds are raised through payroll taxes by employers, employees, and entrepreneurs. There are also other sources like income tax, interests on trust funds and Medicare part-A premiums.
The second source is Supplementary Medical Insurance Trust Fund. It is funded through funds that are authorized by Congress, premiums from the individuals enrolled in Part-B and other sources like interests on trust fund investments (Medicare, 2016).
Mission statement
The mission of Medicare is to advance access to comprehensive Medicare coverage and quality healthcare for the older citizens and also people with disabilities.
Suggested Mission statement
Our mission is to provide quality healthcare for the retired workforce and also individuals with permanent kidney failure and Social Security Disabilities. This mission statement is more effective since it stipulates the elements which are covered by the Medicare program.
Medicaid
Medicaid, on the other hand, is a federal medical insurance program that covers American individuals with low incomes and those that are financially needy. It was set up by the federal government and is located in every state. State and federal taxes fund it, thereby; those who are unable to obtain coverage elsewhere are paid for by wealthy American citizens through taxes (Ridic, Gleason, & Ridic, 2012). However, each state administers the program in a different manner from the other; for instance, it is referred to as Medi-Cal in California. Therefore, every low-income or financially needy person is eligible to be covered by the program. People aged over 65 years and are also on Medicare are also eligible. Information about the delivery system is available in every local or county social service office. Therefore, one must prove that they are poor enough to qualify. Interestingly, only a mere 42% of individuals who apply received Medicaid coverage.
Coverage Medicaid Provides
Comprehensive inpatient and also outpatient health care coverage is offered under the Medicaid program. Such services include costs that are not covered by Medicare, for example, for prescription drugs, eyeglasses, diagnostic care and preventive care. Each state has a different means of payment and amounts of coverage that depends on the state’s per capita income (Ridic, Gleason, & Ridic, 2012). Consumers are only charged small amounts for some services offered by the program. Problems sometimes arise from the low fees that are charged and administrative bureaucracy that makes it difficult to the extent that some doctors cannot see patients that are covered by Medicaid insurance.
Medicaid has been shown to cover around 12% of the American population. It offers health insurance for low-income women, children, the elderly, and the physically challenged. It is the only public health care program that finances long-term nursing home stays (Ridic, Gleason, & Ridic, 2012). Some individuals receive better packages than others depending on the states they are in. Physicians under the system are reimbursed for a certain fee that is fixed by the government depending on the services they provide.
Under both systems, physicians can choose to or not to accept some patients. If they do, they agree to take the fee determined by the government, thereby cannot charge any additional amounts to the patient beyond the usual 20% co-payment (Ridic, Gleason, & Ridic, 2012). Previously, a fee-for-service basis was used for Medicaid beneficiaries whereby participating physicians, clinics or hospitals were paid for their services. However, alternative delivery systems have been developed for the program. Both systems also provide coverage to some children in the US (CMS, 2014).
Mission Statement
Medicaid aims at encouraging better health care for the entire American population by improving individual care through reduced monthly expenditures for each beneficiary. It does this by addressing any underlying causes that may lead to poor health, for instance, poor nutrition, lack of preventive care, physical inactivity, and behavioral risk factors (CMS, 2014).
Suggested Mission Statement
Medicaid aims at bettering healthcare to low-income individuals across the nation by making it possible not to limit care for any ill people. This is so because some commissions have been found to expand cost-saving initiatives that may have limited some patients, especially the mental ill. It will do this by encouraging states and beneficiaries to partner in the provision of better healthcare services for them.
References
Centers for Medicare & Medicaid Services. (2014). Cms.gov.
Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of Health Care Systems in the United States, Germany and Canada. Mat Soc Med, 24(2), 112. http://dx.doi.org/10.5455/msm.2012.24.112-120
Medicare (2016). What's Medicare? Medicare.gov
