Medicare and Medicaid



Medicareand Medicaid

Medicareand Medicaid

Medicareand Medicaid are public health insurance programs which aim atincreasing accessibility and affordability of health care services.Although the main purposes of the two programs are similar, they arevery different principally on how they are run, patient covered oreligibility criteria, services covered and how the users pay. Theprograms have been inexistence in the United States health caresystem since 1965 when President Lyndon Johnson administrationlaunched the ‘great society’ master plan aimed at ensuring thatthe health care system had the capacity to meet the increased healthcare needs. The main similarities between the two program is the factthat both are social health insurance programs that supportfinancially burdened patients by sharing the financial cost betweenthe sick and health individuals who are not covered by commercialhealth insurance programs (Cohen et al, 2015).

Medicaidis a public health insurance program that covers patients withlimited resources and relatively low income. It covers individualsand families with resources that are not sufficient to pay for theirhealth care services or private health insurance programs. Althoughit is managed by the state governments, it is funded by both thefederal government and state governments. The states have a broadleeway provided by the department of medical services to determineeligibility for inclusion in the program. Although it not mandatoryfor the state to have a Medicaid program, all the states have theprograms. Every state has its own regulations and guidelines, inaddition to the blanket guidelines from the federal government.Although it is a major factor in all states, being poor does not makesomeone qualify for coverage by Medicaid. Some of the basicrequirements for eligibility include being a legal resident orcitizen of the United States, children, low income adults and certaindisabilities (Salihu, 2014). Recently, health care reforms introducedby President Obama administration through the “patient protectionand affordable care act” have significantly expanded federalfunding and eligibility to Medicaid. For example, individuals withincome up to 133 percent of the poverty line are eligible. However,the adopting of the legibility expansion by the states is notmandatory (Cohen et al, 2015).

Onthe other hand, Medicare program is a public health insurance programthat covers elderly individuals, 65 years and above, who havecontributed into the program. Additionally, it covers disabledindividuals below the age of 65 as well as those suffering fromamyotrophic lateral sclerosis and end stage renal diseases (Altman &ampFrist, 2015). The program is administered and managed by the federalgovernment with assistance from private insurance companies. Thefederal government manages the program through the center for services in the department of health and humanservices. Individuals covered by Medicare are required to pay smallmonthly premium for non hospital coverage. Generally, Medicare isfunded through payroll tax paid by employers, and premiums paid byenrollees (Cohen et al, 2015).

Boththe programs are faced with eminent financialchallenge in the future. Already, the Medicaid program is a majorbudgetary issue in majority of states. The Medicare program has alsosuffered significantly from the increased cost of medical careespecially due to increased number of elderly people covered by theprogram. Although some statistics that indicates that Medicare willbe insolvency in the next few decades are exaggerated, the program isfaced with a huge challenge. The risk of diminishing funds has beenattributed to increased number of enrollees due to an agingpopulation compared to the number of workers contributing to thesystem (Cohen et al, 2015). Although interventions are likely topropose the insolvency, perhaps indefinitely, these changes willsignificantly affect the program.


Altman,D, &amp Frist, W. H. (2015). &quot at 50Years: Perspectives of Beneficiaries, Health Care Professionals andInstitutions, and Policy Makers&quot. JAMA 314 (4): 384–395.

Cohen,A. et al (2015). at 50: America`sentitlement programs in the age of affordable care, Oxford NewYork: Oxford University Press.

Salihu,H. (2015). ObamaCare simplified: your go-to guide forunderstanding ObamaCare, Bloomington, IN: WestBow Press.