What Is Medicare and Medicaid
In
the U.S, health insurance is mostly in the hands
of the private sector; however there are two
federal government health insurance programs
known as Medicare and Medicaid. These two programs
are supported by the U.S federal government.
Medicaid
Medicare is a health care program by the U.S
federal government for people older than 65
and those with certain disabilities for example
younger people and people with End Stage Renal
Disease (permanent kidney failure requiring
dialysis or a transplant). Medicare provides
for acute hospital care, physician services,
brief stays in skilled nursing facilities and
shot-term skilled home care related to a medical
problem. Medicare coverage is determine not
by a specific diagnoses, but by the nature of
services required by the patients. Medicare
coverage is restricted to medical care only.
It does no include the cost of prescription
drugs, custodial care at home or in nursing
homes. Prescription drug coverage was added
in 2003, but will only take effect in the year
2006.
Medicare was established along with Medicaid
in 1965 by the Social Security Act. It was the
responsibility of the Social Security Administration.
The SSA was an agency of the Department of Health,
Education and Welfare (HEW). In 1977, the Health
Care Financing Administration (HCFA) was created
under HEW to more effectively co-ordinate Medicare
and Medicaid. In 1980, HEW was divided in to
the Department of Education and the Department
of Health and Human Services (HHS). In 2001,
the HCFA was renamed the Centers for Medicare
and Medicaid Services (CMS).
In most places in the country, people who have
Medicare have a choice between a managed care
plan and an indemnity plan. People can switch
or interchange their plans for any reason, but
they must officially inform their change of
plan to the local Social Security Office. It
can take up to 30 days for this change to come
into effect. Medicare has two parts: Part A
(Hospital Insurance), and Part B (Medicare Insurance).
Medical insurance helps cover doctors' services,
outpatient hospital care, and some other medical
services that Part A does not cover. However,
you have to pay a premium for Part B.
In 2003, over 40 million Americans had health
insurance coverage under Medicare. It uses the
Resource-Based Relative Value Scale (RBRVS)
to determine how much each doctor should earn.
Started last year, Medicare-approved drug discount
cards are now available for savings on prescription
drugs. This card offers a discount on the full
retail price of prescription medications. Savings
from these cards are estimated to be between
10-25% on many drugs. These voluntary cards
are on offer until December 31, 2005, when this
program ends. If your income is no more than
$12,569 as a single person, or no more than
$16,862 for a married couple, you can qualify
for a $600 credit to help pay for your prescription
drugs.
Medicaid
Medicaid is a joint federal state program that
covers health services for some low income people,
especially women and children and disabled people.
The coverage and eligibility criteria vary from
state to state. Medicaid is the primary financier
of nursing home care in the country. Additionally,
many states offer some level of home and community-based
care services for Medicaid-entitled individuals.
Such additional services are not mandated by
Federal law but are an option of the state.
The Medicaid program was established along
with the Medicare program in 1965 and provides
health insurance for the poor. It is administered
by the Center for Medicare and Medicaid Services
(CMS) in the United States Department of Health
and Human Services. It’s Children's Health
Insurance Program (CHIP) was setup in 1997.
This program is similar to Medicaid, and aims
to expand health insurance to children whose
families earn more money to be able to qualify
for Medicaid, but not enough to buy their own
private health insurance.
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