Social Policy BP 7: Medicaid and Medicare

Describe Medicaid & Medicare, including how they are administered, who they cover, eligibility, and efforts to cut costs in each program.

Can we talk for a moment about how grad students don’t get a Spring Break? Because we don’t. I went to Colorado for a few days with my son, and I had serious guilt about it. I knew everyone else in the cohort was slaving away on their little laptops, writing papers and other things for all the classes and everything that is due (and STILL managed to all be due at the same time).

That has nothing to do with Medicaid and Medicare. I just needed a moment to vent. Venting done.

I made this little chart that quickly touches on Medicaid and Medicare. One thing I found terribly interesting in the reading is that the Affordable Care Act (Obamacare) was created in part as a stop-gap to keep Medicare from going belly-up! It does appear that, unless the Boomers start actively dying, it will go belly-up sooner than later. And, now that it seems ACA has been chopped with no effective replacement (yet), we can say bye-bye to Medicare very, very soon. But let’s not think about that. Let’s look a my handy-dandy chart instead!

Medicaid

 

Medicare

 

Description

 

Largest public assistance program in the US. Medical coverage and who is covered is determined by the state under broad federal guidelines. Covers: inpatient and outpatient hospital services, prenatal and 60 days postpartum care, vaccines for kids, doctor services, nursing facilities for 21 and over, family planning, rural clinic services, and many other services. 2nd largest social insurance program in the US behind Social Security. Largest public payer of healthcare. Designed to help the elderly with prepaid hospital and optional medical insurance. Part A: Hospital Insurance. Part B: Supplemental Medical Insurance. Part C: Medicare Advantage Program. Part D: Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
How is it administered?

 

Administered through the state. Eligibility varies state-by-state. Administered by the US government. Premiums for Part A are derived from payroll taxes.
Who is covered?

 

Limited and low-income families with children who meet certain requirements. Supplemental Security Income recipients. Infants born to Medicaid-eligible women and through the first year of life. Poor children under 19. Foster and adoption assisted families and children. Other “needy” groups as determined by the state. Part A is provided free for persons 65 or older who are eligible for SS or Railroad Retirement benefits. Other parts of Medicare are available for a premium.
Eligibility

 

Each state has its own guidelines regarding who is eligible. This can cause wide variety among states. A person might be eligible in one state but not in another state, depending on that state’s guidelines. Must be 65 or over and eligible for SS or RR benefits. Part B available to US citizens and approved legal aliens.
Cost cutting measures

 

Many states require that patients on Medicaid also enroll in state-contracted HMOs. Medicare doesn’t cover everything, and there is a 3rd-party “Medigap” insurance available at a premium for things that Medicare doesn’t cover. The Affordable Care Act was also a cost-cutting measure that was projected to keep the Part A trust from going bankrupt until 2029.

Yay! You made it to the bottom of the chart. You are rewarded with a picture of one of my red tulips.

Jill