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Abstract:
Millions of Americans have access to medical treatment through Medicare and
Medicaid, two government-sponsored healthcare programs. Medicaid typically covers low-
income individuals and families, whereas Medicare broadly covers those 65 and older and
those with specific impairments. This study compares and contrasts the two programs by
examining their origins, goals, eligibility requirements, perks, and difficulties. The paper also
includes a comparison of the two programs' prices, scope of services, and efficacy. The
research wraps up with a look into the long-term outlook for Medicare and Medicaid in the
context of the evolving American healthcare system.
Introduction:
In the US, there are two significant government-funded healthcare programs:
Medicare and Medicaid. The most well-known of the two is Medicare. Both of these
initiatives were started in the 1960s to provide health insurance to specific segments of the
population who lacked the resources to do so or were unable to do so for other reasons.
Medicaid is a joint federal-state initiative that offers low-income individuals and families
access to healthcare. The “Kaiser Family Foundation (2021)” notes that Medicare, a
government program, offers health insurance to Americans over 65 and those who have
specific disabilities. The purpose of this report is to provide a comprehensive overview of
Medicare and Medicaid, including their history, eligibility criteria, benefits, and challenges.
The information will also include a comparison of the two programs' costs, coverage, and
effectiveness.
History:
As a part of his Great Society programs, President Lyndon B. Johnson signed the
Medicare program into law in 1965. The program was established to help pay for medical
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care for senior citizens and people with disabilities living in the United States. Several
adjustments have been made to the program since its inception, most recently in 2006, when
prescription drug coverage was included. Medicaid was established in 1965 as part of
President Lyndon B. Johnson's Great Society initiatives. The program aims to guarantee
medical treatment for low-income families and individuals. In contrast to Medicare,
Medicaid is jointly administered and funded by the federal government and individual states
(Kaiser Family Foundation. (2021).
Eligibility Criteria:
Medicare and Medicaid have quite different eligibility requirements. Individuals not
meeting the Medicare age or disability criteria will not receive Medicare benefits. Medicare
eligibility criteria include age 65 or above or a permanent and total disability. Medicare also
covers those who have amyotrophic lateral sclerosis (ALS) or end-stage renal disease
(ESRD). Medicaid, on the other hand, is meant to pay the medical expenses of low-income
people. Eligibility for Medicaid is based on both income and definite requirements.
Regarding income, the eligibility threshold varies by state and is based on the Federal
Poverty Level (FPL). The FPL is updated annually and takes into account household size,
income, and other factors. Individuals who meet the income requirements must also meet
specific categorical requirements to be eligible for Medicaid.
The absolute requirement for Medicaid is to target specific groups of people who may
have difficulty accessing healthcare or affording it independently. These categories typically
include pregnant women, children, individuals with disabilities, and older adults. States may
also choose to expand Medicaid coverage to include additional categories of people, such as
adults without dependent children or those with certain medical conditions (Kaiser Family
Foundation. (2021). Medicaid eligibility rules can be complex and vary by state. However,
Medicaid is an important safety net for many low-income Americans who may not have
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access to affordable health insurance. Medicaid has played a critical role in expanding access
to healthcare and reducing disparities in health outcomes for vulnerable populations.
Benefits:
In terms of benefits, Medicare and Medicaid differ in the services they cover.
Medicare pays for a wide range of medical treatment, including doctor visits, medications on
prescription, and even specific preventative care. The preventive services covered by
Medicare include mammograms, flu shots, and colorectal cancer screenings, among others.
These services are essential for promoting good health and preventing serious health
conditions. Medicaid covers a wide variety of services, including many that Medicare does
not, such as prescription medicines, long-term care, and other forms of assistance. These
additional services include dental care, vision care, and hearing care. Medicaid also covers
home health services and nursing home care, which can be critical for individuals who need
long-term care. The availability of dental and vision coverage is essential for low-income
individuals, who may not have access to these services otherwise. Medicaid's coverage of
these services can help to improve overall health outcomes and quality of life for eligible
individuals. In addition, Medicaid's coverage of long-term care can provide a lifeline for
individuals who require ongoing medical attention but cannot afford to pay for it out of
pocket.
Both Medicare and Medicaid provide critical health coverage to millions of
Americans. While Medicare provides coverage primarily for older adults and those with
disabilities, Medicaid serves as a safety net for low-income individuals who may not have
access to affordable healthcare otherwise. Both programs offer important benefits that help to
promote good health and improve the quality of life for those who are eligible. According to
a study by the Commonwealth Fund, Medicaid's coverage of additional services like dental
and vision care, as well as long-term care, is associated with improved health outcomes and
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reduced healthcare costs (The Commonwealth Fund, 2021). This highlights the importance of
Medicaid's role in providing comprehensive health coverage to vulnerable populations.
Challenges:
One of the main challenges facing Medicare is the rising cost of healthcare. The
program's costs are projected to increase rapidly in the coming years due to the aging
population and advances in medical technology. Additionally, Medicare's fee-for-service
payment model has been criticized for incentivizing providers to perform unnecessary
procedures and tests. One of the main challenges facing Medicaid is the strain it places on
state budgets. The federal government provides financing for the program, while the states
are responsible for its administration and funding. As healthcare costs continue to rise, many
states are struggling to keep up with the program's costs.
Comparative Analysis:
In terms of cost, Medicare is more expensive than Medicaid. In 2021, Medicare is
expected to cost $829 billion, while Medicaid is expected to cost $440 billion. However, this
cost difference is due to the fact that Medicare covers a much larger population than
Medicaid. In terms of coverage, Medicaid covers a broader range of services than Medicare.
Medicaid covers long-term care services, dental care, and vision care, which are not covered
by Medicare. Medicaid also covers home healthcare services and transportation to medical
appointments (The Commonwealth Fund. (2021).
In terms of efficiency, Medicaid has a lower administrative cost than Medicare.
Medicaid's administrative costs are around 6%, while Medicare's administrative costs are
about 2%. This is due to Medicaid's partnership with the states, which allows for more
localized and efficient administration of the program. Medicare and Medicaid also have
different reimbursement models. Medicare is a fee-for-service program, meaning doctors are
paid for every patient visit. It has been argued that this encourages doctors to do needless
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operations and testing for financial gain. However, Medicaid operates under a managed care
model in which providers are paid a flat rate per patient per month, regardless of the level of
care they provide. The Commonwealth Fund (2021) commended this concept for its success
in fostering better care coordination and patient prevention.
Future of Medicare and Medicaid:
The future of “Medicare and Medicaid” is uncertain as healthcare costs continue to
rise and the healthcare landscape in the United States continues to change. One potential
solution to the rising costs of healthcare is to move away from the fee-for-service model used
by Medicare and towards a more value-based payment model. Providers would be
encouraged to prioritize patient outcomes above patient volume. As the population ages,
long-term care services will be in more demand. This may prompt a greater emphasis on
Medicaid's services for long-term care or an increase in Medicare's coverage.
Conclusion:
Finally, millions of Americans are covered by Medicare and Medicaid, two essential
healthcare programs. Both are essential to guarantee that all Americans can get medical care,
and each has benefits as well as drawbacks. The future of Medicare and Medicaid will
depend on the ability of policymakers to address the rising costs of healthcare and to adapt to
the changing healthcare landscape in the United States.
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References:
Centers for Medicare & Medicaid Services. (2021). National Health Expenditure Projections
2019-2028. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/NationalHealthAccountsProjected
Kaiser Family Foundation. (2021). Critical Facts About Medicare. Retrieved from
https://www.kff.org/medicare/issue-brief/key-facts-about-medicare/
Kaiser Family Foundation. (2021). Medicaid: A Primer. Retrieved from
https://www.kff.org/medicaid/report/medicaid-a-primer-2021/
National Conference of State Legislatures. (2018). Medicaid Payment and Delivery System
Reform: Managed Care. Retrieved from
https://www.ncsl.org/research/health/medicaid-payment-and-delivery-system-reform-
managed-care.aspx
The Commonwealth Fund. (2021). Medicare vs. Medicaid: How Do They Compare?
Retrieved from https://www.commonwealthfund.org/publications/issue-
briefs/2021/apr/medicare-vs-medicaid-how-do-they-compare
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