Medicare Amp Medicaid

Running head: MEDICARE & MEDICAID 1

Medicare & Medicaid

Name

Institutional Affiliation

MEDICARE & MEDICAID 2

In the United States, there are groups of people who are given priority in the delivery of

medical services. The Medicare and Medicaid are some of the most popular systems that

designed and implemented for medical protection of privileged groups. According to (Center for

Medicare & Medicaid Services, 2010), the privileged groups fall under the elderly that are 65

years or older, young people with disabilities and individuals who have kidney failures that

require dialysis or a transplant. According to the federal system of the United States, there are

rules and regulations that must be met for an individual to be qualified for the Medicare health

insurance program (Newman, 2012). The government is fully responsible for settling the bills

pertaining to taking care of the individuals who fall under the mentioned groups. The paper will

highlight some of the qualifications required for an individual to be considered for the Medicare

insurance program. Also, the latter part of the paper will highlight to some essential remedies

that can be implemented to include more people who need the insurance program in the

underprivileged populations.

(Newman, 2012) cites that, Medicare is divide into two parts which include part A and

part B. there are different criteria for qualifying for both part A and part B with part B being the

most important for most people. First off, when one attains the age of 65, it is automatic for them

to be enrolled into the part A of the Medicare which only includes medical insurance. This is also

a qualification for social security. To get the part B of the Medicare program, one is require to

enroll separately. This means that when one attains the age of 65 years, they are automatically

enrolled into the medical insurance and social security (Part, 2012). However, the other part has

to be done separately with an exception of some people. It is cited that when an individual is

already receiving benefits from the social security or the rail road retirement board by the time

they attain 65 years, then they are automatically enrolled into part B of the Medicare Insurance

MEDICARE & MEDICAID 3

program. This poses a great challenge to people as some do not understand how this concepts

work (Newman, 2012). Some who attain the age of 65 and do not have the benefits from the

social security fail to enroll for the part B of the Medicare and end up not being fully covered.

As stated earlier in the introduction, it is a requirement that an individual has to be

completely disabled. In addition to this, if the disabled person has continually received benefits

from the Social security and the rail road retirement Board for a period of 24 months, then they

automatically get enrolled into both part A and B of the Medicare program. It is therefore

important for the disabled people to enroll to the social security so that the benefits they receive

can be tracked for the 24 months and they would be gradually enrolled into the Medicare

insurance program.

For some medical conditions, I is difficult to know unless one goes for a diagnosis. The

kidney is one of the vital organs of the body that when they fail, it can be fatal to the human

health. For this reason, individuals that are considered to be suffering from kidney failure to an

extent that they require dialysis or a transplant are considered in the Medicare program (Center

for Medicare & Medicaid Services, 2010). The patients with kidney failure should however,

enroll to the social security as the enrolment is not automatic. It should be noted that, if patients

having kidney failure do not enroll, they may not enjoy the benefits of the Medicare insurance

program.

Individuals suffering from ALS automatically get enrolled to bot part A and B of the

Medicare program once they start receiving their social security benefits.

It is further indicated that failure to enroll in the Medicare program at the earliest age

when one is required to could attract a penalty of 10% for every 12 months one fails to sign up.

This could be expensive for people who fail to enroll once they reach the age of 6 years.

MEDICARE & MEDICAID 4

Therefore, it is important for all the qualified individuals to make an effort to enroll themselves

in part B of the social security as it may not be automatic for those suffering from kidney failure

or ALS.

From the above findings, adjustments could be made to include populations that are more

vulnerable in the society. First off, it should take into account patients suffering from other

critical ailments such as cancer. Since cancer is known to be a world killer, people having this

condition should be enrolled to part A of the program (Center for Medicare & Medicaid

Services, 2010). Nevertheless, the same patients should be enrolled into part B when the cancer

is beyond treatment. The process should be made automatic to make it easier for such people.

Further, the program could be adjusted to include the poor and needy in the society.

There are populations in the nation that cannot afford decent medical treatments due to the high

costs. For this reason, it would be important to include this group into the parts of the Medicare

program. However, this could also include introduction of part C of the program that could

accommodate the group mentioned.

Benefits of Medicaid.

Medicaid is a medical program that is created by the federal government and

implemented by the state that provides financial support to low income earners. There are a

number of benefits that accrue from the Medicaid in different states. As cited by (Newman,

2012), the selected populations can get affordable home health services, rural health clinic

services, nursing facility services. Also, the populations get access to other professionals such as

physicians and counsellors who give them professional advice about issues affecting their health

or persona lives. Therefore, it is clear that the Medicaid does not only provide affordable medical

MEDICARE & MEDICAID 5

services but also has more benefits for the low income earners in the society (Center for

Medicare & Medicaid Services, 2010).

The affordable care act was changed in the year 2014 which affected many people who

benefit from the Medicare and Medicaid programs. Research shows that the introduction of the

changes suggested by the affordable care act affected the eligibility of the people who should

qualify for the Medicare program. Additionally, it is also cited that the changes greatly affected

people with disabilities (Center for Medicare & Medicaid Services, 2010). Their access to the

social security was limited by the new more strict measures introduced by the affordable care act.

Comparing the disabled people covered under the Medicare and Medicaid with those covered by

the private insurance, the latter appeared to be healthier while the former were reported as being

more disabled (Center for Medicare & Medicaid Services, 2010).

Further, the affordable care act introduced a new income counting methodology. This

made it possible to calculate the incomes of people who could be eligible to be selected as

qualified for the program. The application and renewal processes of the Medicare and Medicaid

program were complicated by the introduction of the act. When the minimum wage was raised, it

meant that those who enjoyed the benefits of the two programs could be denied the same. This

greatly affected many poor people as they could not afford good medical care from the low

income that they got.

The Medicare insurance programs were accompanied by premiums. The members who

enroll for part B of the insurance are required to pay premiums every month. These premiums

are directed to the members accounts and they are able to receive medical help whenever the

need arises. However, the premiums are normally of different values depending on the level of

income of the patients (Newman, 2012). Usually, patients who earn a higher income would tend

MEDICARE & MEDICAID 6

to go to hospitals that charge a high fee while those with low income will go to hospitals that

they can afford. Using the same concept, the insurance companies offering the Medicare would

ask for higher premiums form the high income earners and low premiums for the income earners.

The insurance providers are also considerate that they cannot ask for higher premiums from

individuals who earn a lower income. Additionally, it is also reported that depending on the

complication an individual is enrolled with, they pay different premiums. For instance, when a

person is enrolled with a kidney failure, they are required to pay higher premiums than an

individual who attains an age of 65 years and enrolls to a part B plan.

MEDICARE & MEDICAID 7

References

Centers for Medicare & Medicaid Services (CMS), HHS. (2010). Medicare and Medicaid

programs; electronic health record incentive program. Final rule. Federal

Newman, H. N. (2012). Medicare and Medicaid. The ANNALS of the American Academy of

Political and Social Science, 399(1), 114-124.

Part, M. (2012). Medicare and Medicaid. Drugs.

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