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M09.05.004 Medicare and Medicaid
Medicare and Medicaid are vital federal social healthcare programs in the United States, designed to provide health coverage to specific populations. They originated from amendments to the Social Security Act and play crucial roles in the American healthcare system.
Medicare
Eligibility
- Age: Available to individuals aged 65 and older.
- Disabilities: Available for individuals under 65 with certain disabilities.
- End-Stage Renal Disease: Covers individuals diagnosed with end-stage renal disease (ESRD).
Key Characteristics
- Focus: Primarily serves the elderly population.
Medicaid
Eligibility
- Income and Resources: Joint federal and state programs designed for individuals with limited income and/or resources.
Key Characteristics
- Focus: Aim to assist low-income individuals and families.
Distinction Between Medicare and Medicaid
| Program | Target Population | Key Features |
|---|---|---|
| Medicare | Elderly (≥ 65 years), individuals with disabilities or ESRD | The joint federal-state program, varies by state, offers broader services including long-term care |
| Medicaid | Low-income individuals and families | The joint federal-state program, which varies by state, offers broader services including long-term care |
Parts of Medicare
Medicare consists of four main parts, each designed to cover different aspects of healthcare:
| Part | Description | Coverage |
|---|---|---|
| Part A | Hospital insurance and home hospice care | Inpatient hospital stays, skilled nursing facility care, hospice care, some home health care |
| Part B | Basic medical insurance | Doctor’s visits, outpatient care, preventive services, diagnostic testing |
| Part C | Medicare Advantage Plan (combines A & B) | Offered by approved private companies, includes all benefits of Parts A and B, often includes additional services |
| Part D | Prescription drug coverage | Helps cover the cost of prescription medications |
Points to Remember
- Medicare: Primarily for elderly individuals, disabled persons under 65, and those with ESRD.
- Medicaid: Designed to assist individuals and families with limited financial resources.
- Medicare Parts: Each part provides specific coverage, ensuring a comprehensive approach to healthcare.
Bibliography
- Centers for Medicare & Medicaid Services. (n.d.). Medicare.
- Centers for Medicare & Medicaid Services. (n.d.). Medicaid.
- Social Security Administration. (n.d.). Understanding Medicare and Medicaid.
- National Association of Insurance Commissioners. (n.d.). Medicare & Medicaid Basics.