Healthcare industry Essays

Healthcare industry Essays Healthcare industry Paper Healthcare industry Paper Medicare and Medicaid are health insurance programs that are administered by   Ã‚  the U.S. Department of Health and Human Services (CMS-HHS, 2007).   There are basic differences between the two health insurance programs.   Medicare is designed to provide health support services to individuals at least 65 years old and older, to individuals below 65 years of age but have particular disability, and to individuals of any age who have end-stage kidney diseases. On the other hand, Medicaid is designed to provide health support services to individuals who receive a particularly low income.   Federal and state legislations have been created as a guide to determine which individuals and families are eligible for inclusion into this health insurance program.   The eligibility criteria for Medicaid are different for each state of the United States. The health coverage of Medicare is comprised of 3 parts (Cook et al., 2007).   Part A provides hospital coverage which includes hospital and nursing or hospice facilities.   Part B provides coverage for the professional fees of physicians as well as outpatient care.   Prescription drugs are another component supported by Medicare, which significantly reduces the cost of pharmaceutical drugs and regulates prescription drug rates from increasing.   Medicaid, on the other hand, follows Title XIX of the Social Security Act, which states the medical assistance should be offered for particular basic services to the most deprived individuals in the United States. These basic services include in- and outpatient hospital services, prenatal care, vaccinations for children, laboratory tests and nursing services.   Other states, depending on the federal funds provided, may also offer other services such as diagnostic tests, prescription drugs and rehabilitation services.   Hence the services of Medicaid are not as freely accessible as that provided by Medicare. Another difference between Medicare and Medicaid concerns the monthly payments for the health insurance program.   In the case of Medicare, members have to pay premium for at least Part B which is the medical insurance.   The premium is approximately $78.20 per month, covering the physician services and outpatient care.   Majority of the members of Medicare do not pay the premium for Part A or the hospital insurance because they already pay for Medicare taxes when they were still working (West and Weeks, 2007). In the case of Medicaid, there is a very minimal premium that has to be paid for by the individual, but there is a rigorous criterion during the application process for Medicaid.   It is known that individuals who receive Medicaid assistance are the poorest people in the United States hence there is no need to pay a monthly premium.   One of the major requirements for Medicaid is that the individual falls below 133% of the federal poverty line, hence not all poor individuals can avail of the Medicaid support services. There are three components associated with the eligibility for reimbursement.   Firstly, the individual must have substantial proof that he receives a low income.   Secondly, the individual should be able to show that his assets and resources are below substantial levels. This will consider whether the individual receives any financial assistance from the Temporary Assistance for Needy Families (TANF) or the Supplemental Security Income (SSI) programs.   Thirdly, the individual will only be able to get a reimbursement is he is able to show that he is experiencing excessive medical expenses. References Centers for Medicare Medicaid Services (CMS) and Human and Health Services (2007):   Medicare and Medicaid programs; hospital conditions of participation: laboratory services: Interim final rule with comment period.   Fed. Regist. 72(164):48562-74. Cook NL, Hicks LS, OMalley AJ, Keegan T, Guadagnoli E and Landon BE (2007):  Ã‚   Access to specialty care and medical services in community health centers.   Health Aff (Millwood). 26(5):1459-68. West AN and Weeks WB (2007):   Who Pays When VA Users Are Hospitalized in the Private Sector?: Evidence From Three Data Sources.   Med. Care. 45(10):1003-1007.