The Basics on Medicaid and Medicare

Medicaid and Medicare are crucial programs for practicing physicians, members of the American Medical Association, and the entire nation. The programs were developed in 1965 to aid certain categories of individuals making use of their medical costs. Today, Medicaid provides coverage to over 50 million Americans while Medicare aids over 45 million. These numbers make Medicaid and Medicare the biggest source of medical funding in our nation.

Being interested in the programs, I completed some research on their general information. The basic principles are described in this article. After reading through each program description, you might find how different and important Medicaid and Medicare are.

Medicaid

Medicaid is a course designed to assist US individuals and families that fall into certain eligible categories. Although the main qualifying category is low income, it's not the defining factor. For example, many poverty stricken individuals cannot receive Medicaid as a result of other qualifying aspects. The other eligibility requirements include measures like your actual age, pregnancy status, citizenship, and disability like blindness.

The Medicaid program is funded by both their state and federal government. The funding, program name, and process requirements can differ from state to state. The states administer their very own program but receive a portion of federal funds beneath the notion that they have to adhere to the federal requirements regarding service, funding, quality, and eligibility. These requirements are monitored by the Centers for Medicare and Medicaid Services (CMS).

Those receiving Medicaid receive specific inpatient and outpatient coverage and they have the option of dental care and Prescription Drug Rebates. With regards to the category they fall under, they could be required to pay for some out of pocket costs like co pays to doctors or providers. But, the out of pocket costs are often much below higher income individuals which may receive medical insurance through their employer.

Medicare

Medicare, on the other hand, is a social insurance program in place providing healthcare coverage to those 65 years or older, individuals with certain disabilities, or individuals with permanent kidney failure. The government is the only real funder of the Medicare program. Although it is administered on a federal level, it is still monitored by the CMS.

There are four different elements to Medicare: Hospital Insurance (Medicare Part A), Medical Insurance (Medicare Part B), Medicare Advantage Plans (Medicare Part C), and Prescription Drug Plans (Medicare Part D).

o Part A covers inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care. Members who have Part A coverage typically do not pay any monthly premiums simply because they already contributed through taxes taken while working. Individuals that have not completed the necessary tax contributions can still elect for Part A coverage nevertheless they must pay a premium.
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o Part B covers doctor services, outpatient care, some physical and occupational therapy, and some home health care. Those who elect Part B will pay a regular premium, just like the premium paid when receiving medical coverage during your employer. This can help explain one of the reasons for having reduced attached with Part B. Many individuals don't elect Part B simply because they receive their medical insurance through their current or previous job.

o Part C is also referred to as Medicare Choice or Medicare Advantage. It is a means for individuals to receive Medicare coverage, but it is through private health insurance plans of these choice. The individuals pay their insurance provider a premium. Medicare also pays the provider a collection amount for every Medicare member the company covers. Medicare Advantage allows the ones that are able the premiums to take advantage of prescription drug coverage, dental care, vision care, and numerous other things not included in traditional Part A or Part B programs.

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