Introduction
In the United States, the incremental movement towards providing and securing healthcare has pushed the state and federal governments to finance various programs, such as Medicare and Medicaid. These two government-sponsored programs are designed to cover healthcare costs for eligible American citizens who enjoy a wide array of specific services funded by the programs. As the demand and costs for long-term care surge, Medicare and Medicaid enhance the quality of care and cushion customers against exorbitant healthcare costs.
Medicare Services and Populations Covered
Medicare is the most extensive government-sponsored insurance program run by the Centers for Medicare and Medicaid Services (CMS). The program covers healthcare costs of U.S citizens aged over 65 years regardless of their income, patients diagnosed with end-stage renal diseases, and young people living with disabilities. Medicare is America’s largest payer of medical costs associated with inpatient hospital services and supports individuals from an array of specialized groups.
Medicare provides various services categorized under Part A, B, C, and D. Part A of Medicare offers hospitalization coverage for the elderly aged 65 years or older, hospice, and short-term skilled care in healthcare facilities (Centers for Medicare and Medicaid Services [CMS] 2018). Part B covers numerous durable medical equipment, such as walkers, and home health and physician services, including lab works, disease screenings, and flu shots (CMS, 2018). Additionally, this section encompasses various short-term post-acute care, such as rehabilitation services at home or in a skilled nursing facility. Part C integrates all the services and benefits covered under Parts A and B, and other additional benefits at extra costs, such as dental, vision, and hearing coverage (CMS, 2018). Enrolling for Part C reduces the costs of procuring specific services separately. Part D of Medicare is a standalone optional scheme and covers prescription drug costs (CMS, 2018). Therefore, Medicare has an array of services, which means that the citizens should understand its components to get the right coverage that meets their needs.
Medicaid Services and Populations Covered
Medicaid is an elaborate network of statewide programs rolled out by state governments through broad national guidelines and standards established by Federal regulations, policies, and statutes. The program is America’s largest payer of long-term care services, mental health services, and covers about 40% of all childbirth costs (Branning & Vater, 2016). The federal government mandates all states to cover the elderly, children, adolescents, pregnant women, youths aging out of foster care, and specific classes of people with disabilities and blindness (CMS, 2018). Medicaid is a joint program between the federal and state governments that targets low-income earners of all ages to pay for costs emanating from medical and long-term custodial care. Therefore, Medicaid is designed to provide coverage for low-income adults, children, and pregnant women in the United States.
Under federal government regulations, states are obligated to cover specific services under their Medicaid programs. These services include doctor visits, mental health services, needed medication, prenatal and maternity care, outpatient, and inpatient hospital services (CMS, 2018). Additionally, the program covers preventive care costs, such as colonoscopies, immunizations, and mammograms (CMS, 2018). However, states may opt to cover additional services, such as prosthetic devices, physical therapy, and home and community-based services. Therefore, federal and state governments collaborate to provide Medicaid services to the American people.
Services of Long-Term Care Covered Under Medicaid and Medicare and Imposed Restrictions
In the United States, there is no universal and comprehensive coverage provision for long-term care services. Medicare and other employer-sponsored programs only cover costs of long-term care temporarily by offsetting nursing home-based rehabilitation costs after a hospital discharge (Werner et al, 2020). From this perspective, most Americans offset their long-term care costs out of their pockets. However, Medicaid is the ideal funding source for various long-term services and support, including personal care, nursing facility care, home health services, and community-based care (CMS, 2018). In 2016, Medicaid’s expenditure on long-term care services and support for federal and state governments accounted for 42.2% of all long-term care expenditures (Colello, 2018). Therefore, American citizens should take advantage of both Medicare and Medicaid to benefit from their long-term care services.
Although Medicaid and Medicare provide many services to the people, they have specific limitations regarding their coverage and eligibility. Medicare is limited to full cost payment of up to the first 20 days of hospitalization, after which the patient is required to co-offset the balance for a maximum of 100 days of hospital stay (Sollitto, 2020). Additionally, the program offers hospice cover for people with terminal illnesses no longer seeking care, who are expected to live no more than six months (Sollitto, 2020). However, eligibility for Medicaid long-term care and support is subject to asset and income limits (Sollitto, 2020). Both Medicaid and Medicare’s provision of long-term care is not comprehensive.
Conclusion
Although there is no comprehensive and universal healthcare program in the United States, Americans can immensely benefit from Medicare and Medicaid. People should educate themselves about the various services provided by both programs since they have restrictions and limitations. Age, income, and healthcare needs are vital factors contributing to people’s eligibility for Medicare and Medicaid. Conclusively, Medicare and Medicaid coverage is advantageous for Americans since they reduce the financial burden of healthcare costs.
References
Branning, G., & Vater, M. (2016). Healthcare spending: Plenty of blame to go around. American Health & Drug Benefits, 9(8), 445–447.
Centers for Medicare and Medicaid Services (2018). Medicare and Medicaid basics.
Colello, K. J. (2018). Who pays for long-term services and supports? Congressional Research Service.
Werner, R., Hoffman, A., & Coe, N. (2020). Long-term care policy after Covid-19 — Solving the nursing home crisis. New England Journal of Medicine, 383(10), 903-905.