AbstractThe prior conditions. Medicare provides health insurance

AbstractThe purpose of this research is to explore three different government funded health care programs. Affordable Care Act (ACA) or Obama Care, Medicare, and Medicaid. Affordable Care Act was designed to make health insurance available to more people, covering individuals of varies age groups, individuals who make below a standard income, and for those with prior conditions. Medicare provides health insurance to people over sixty-five. Also, health coverage to those with permanent disabilities, and ESRD. Medicaid is a federal and state funded programs that assist with health coverage to those with low assets, pregnant women, children, the elderly and individuals with disabilities.Essentially, Medicare and Medicaid are two federal funding programs that provide medial and health services to a specific demographic of people who meets a certain criteria in the United States. Although the two government programs have their differences they are both managed by the Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid services is a division of the United States of Health and Human Services. Medicare is the federal health insurance program for the elderly who are sixty-five years old or older. Certain individuals under sixty-five years old with disabilities, and residents with End-Stage Renal Disease are also covered under Medicare. “With the rapid increase in the prevalence of type II diabetes and the aging of the population, the annual number of new patients entering ERSD program is expected to increase from 100,359 in 2003 to 460,000 in 2030 (Collins et al., 2005).” (DeWalt et al., 2005). Kidney failure is also referred to as end-stage renal disease. ESRD is the last stage of chronic kidney disease when the kidney are no longer functioning without dialysis or kidney transplant.There are four portions of Medicare assistance which covers specific services Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. Medicare Part A provides coverage for inpatient hospital care, patients stays in majority of skilled nursing facilities, hospice, and home health services. Medicare Part B provides coverage for preventive care, long lasting medical equipment, supplies, outpatient services, lab tests, screenings, x-rays, surgical fees, mental health care, and physical therapy. Insurance coverage for home health and ambulance services may vary when it comes down to Medicare Part B. Medicare Part C is also know as Medicare Advantage. With Part C individuals will receive Medicare Part A and Medicare Part B coverage through Medicare Advantage and not Medicare. Medicare Part D covers prescription drug expenses. Part D not only covers the cost of prescription drugs, but also prescription drug insurance premiums for Medicare recipients.Medicare Advantage Plans can also be added with Part D prescription drug coverage creating a Medicare Advantage Prescription Drug Plan. Normally these plans are offered as; Medicare Advantage Private Fee for Service, Medicare Advantage Health Maintenance Organizations, and Medicare Advantage Preferred Provider Organization. Medicare Advantage PrivateFee for Service plans determines the total amount that doctors, and hospitals will receive as well as how much the patient will pay for service. Medicare Advantage Health Maintenance Organizations cover only health care providers in the plan’s network not including emergencies. Medicare Advantage Preferred Provider Organizations involves paying less if they use doctors, and hospitals that are within the plan’s network. To be eligible for Medicare Part A and Part B an individual must be a citizen of the United States or a permanent legal resident for at least five consecutive years. To meet the standards a person also has to be sixty-five years of age and eligible for Social Security. Social Security is a federal insurance program that provides benefits to retired people and those who are unemployed, or disabled. Furthermore, if citizens are receiving funds from Social Security or the Railroad Retirement Board, residents will automatically receive Part A and Part B starting the first day oh the month of turning sixty-five. If permanently disabled and receiving a minimum of two years, someone may be able to automatically receive Part A and Part B after receiving disability benefits from Social Security for twenty-four months. Another special circumstance for receiving Part A and Part B is if diagnosed with Amyotrophic Lateral Sclerosis or ALS. Amyotrophic Lateral Sclerosis is a ¬†neurodegenerative disease that progressively affects nerve cells in the brain and spine. People with ALS also known as Lou Gehrig’s disease may lose the ability to speak, breathe, eat and mobility. Automatically residents are enrolled into Medicare Part A when sixty-five and become eligible for Social Security, but if Medicare Part B is needed an individual has to be enrolled.Only thirty-two states and Washington D.C. provides Medicaid benefits to residents eligible for Supplemental Security Income. In these states, SSI is basically the Medicaid application. Medicaid eligibility starts the same months as SSI eligibility. “Opportunities for bipartisan compromise to improve Medicaid’s value may lie in greater flexibility for states, realignment of incentives related to long-term services, improved integration of physical and behavioral health care, and efforts to lower drug costs.” (McConnell , 2017). Each state runs several different Medicaid funded programs for different groups of people. All states’ program have some things in common. For example, each state must cover certain groups of people including; older people, people with disabilities, pregnant women and children. However, the financial eligibility levels for these different groups do not have the same requirements. Each states have programs to cover the cost of nursing home care for people with limited incomes and assets. Each state have programs to provide home and community based care to people with limited income and need long-term care services. All states use financial eligibility rules to determine whether you are eligible for Medicare coverage. Usually, an individual’s income must be below a set amount to qualify, but the amount varies in each state.The Children’s health Insurance Program or CHIP was established in August 1997. The goal of the program was to expand health insurance coverage for low income and uninsured children. In comparison to previous in public coverage, the CHIP legislation comprehensively sought to target the program for those who are uninsured. This focus led to the legislative criteria that states implement measures to prevent the exchange of public coverage for private coverage. Another aim for legislative’s requirement was so that states maintain their Medicaid eligibility maximum limit at pre-CHIP levels and not cover children under CHIP. “Implementation of the CHIP program resulted in large increases in public coverage with estimates of crowd-out consistent with initial projections made by the Congressional Budget Office. Studies have demonstrated that public health insurance expansions can lead to substantial reductions in those without insurance causing a major decline of employer coverage.” (Dubay & Kennedy, 2009).¬†Eligible citizens can have both Medicare and Medicare and Medicaid. Medicaid can typically cover services that Medicare criteria excludes such as; extended long-term care. It will also cover Medicare’s out of pocket costs like deductibles, coinsurance, and copayment. A deductible is the set amount of money that the insured must meet before an insurance company pay out on a claim. Coinsurance is when the insured pays a portion of the payment made against a claim. Copayment is a payment made by the insured. “The program once derided as a “poor program for poor people” has marked its golden anniversary, outpaced Medicare to now cover 72 million people, (CMS, 2015), achieved recognition for its achievements in maternal and child health and long-term care (Iglehart, 2015), and solidified its role as a cost-effective way to expand coverage (Sparer, 2015).” (Quinn et al., 2016). Thanks to taxpayers low income families, the elderly, the disabled, pregnant woman, and children can receive adequate health care services. The elderly and permanently disabled are eligible to obtain financial assistance with hospital care, physical therapy, home health care and preventive care. Women who are expecting and have limited income are covered for all treatment related to pregnancy, the delivery and any unexpected complications that may occur during pregnancy, and approximately sixty days postpartum. Children’s Medicaid recipients are able to qualify for dental services, eye exams, annual checkups, prescription drugs, vaccines, office visits, access to medical specialist, mental health care, hospital care, x-rays, and lab tests.

x

Hi!
I'm James!

Would you like to get a custom essay? How about receiving a customized one?

Check it out