Both Medicare and Medicaid are health insurance covers for patients but they differ on the categorization of patients insured. Both of them are meant to increase access to healthcare services. Medicare is health insurance for individuals from the age of 65; those younger than 65 years but with certain disabilities; and individuals with end-stage renal disease regardless of age (Centers for Medicare & Medicaid Services, 2015). Medicaid, on the other hand, is a ‘joint federal and state’ program meant to help individuals with limited resources and income to cater for their medical costs (Centers for Medicare & Medicaid Services, 2015, par. 7). Medicaid is broader than Medicare because it covers services that are not included in the Medicare program, for example, personal care services. Application for Medicaid is a unique procedure for each state and eligibility is based on the following:
- Limited income
- Prevailing disability
- Children <19 years
- Children care-givers
- An adult without children
The Affordable Care Act (ACA) was developed as a measure of healthcare reform to increase healthcare insurance coverage with the use of Medicare and Medicaid programs. Despite these reforms, there are still millions of individuals in the U.S. who are uninsured while some of the insured individuals are not able to access affordable, high-quality healthcare (Sommers, 2015). Some people who are eligible for these health programs remain uninsured because there is a lack of proper education on the functions and eligibility of these programs. Sommers (2015) highlights that some states deliberately deprive eligible but uninsured individuals of the application assistance they require.
Medicare part A is free for individuals that paid Medicare taxes at the time they were working, while Medicare part B requires one to pay a standard monthly premium. However, any other individual wishing to acquire can pay premiums as advised. Medicare part A insurance covers “inpatient care, skilled nursing facility care, hospice care, and home health care” while Medicare part B covers “outpatient care, home health care, services obtained from healthcare providers, some preventive services, and durable medical equipment” (Centers for Medicare & Medicaid Services, 2015, par. 1-8).
The ACA has led to the development of policies that limit access to healthcare as healthcare providers aim to reduce hospital readmissions, a measure that determines the number of financial incentives a hospital gets (Bhalla & Kalkut, 2010). The socioeconomic situations of both patients A and B differ anecdotally, and these are believed to affect progression and outcomes. Based on these socioeconomic factors, patient B does not have adequate resources and means to manage his condition as effectively as patient A manages his. Therefore, there is a high probability that health outcomes and utilization of healthcare services inpatient B will be poorer as opposed to those of patient A. Therefore, in order to reduce hospital readmission, optimal hospital performance is important. The essence of the Medicare-Medicaid financial incentive program was meant to improve the overall quality of healthcare. Healthcare providers should ensure that their patients, and especially those with limited access to resources, enroll in healthcare plan programs to ensure that therapy continues without interruptions even after discharge. Health education and promotional activities should help healthcare workers achieve their objectives in the provision of high-quality healthcare services as indicated by Silow-Carroll and Rodin (2013).
Medicare-Medicaid programs are imperative in ensuring individuals are able to access healthcare despite their financial limitations. Healthcare providers should not perceive the ACA and associated healthcare plans are a means of increasing healthcare disparities. Rather, it is a wakeup call for the healthcare practitioners to go the extra mile of ensuring their patients do well even after discharge from the hospital. Education and promotion activities should be at the forefront in ensuring patients attain quality healthcare.
Bhalla, R., & Kalkut, G. (2010). Could Medicare readmission policy exacerbate health care system inequity? Annals of Internal Medicine, 152, 114-117.
Centers for Medicare & Medicaid Services. (2015). What’s Medicare? Web.
Silow-Carroll, S., & Rodin, D. (2013). Forging community partnerships to improve health care: The experience of four Medicaid managed care organizations. The Commonwealth Fund, 19, 1-17.
Sommers, B. D. (2015). Health care reform’s unfinished work-Remaining barriers to coverage and access. The New England Journal of Medicine, 373, 2395-2397.