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Medicare Advantages And Disadvantages

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The purpose of this paper is to explain why unlike Medicare, Medicaid eligibility rules and coverage vary between states and to also discuss the advantages and disadvantages of the current state-oriented Medicaid system. Although both health care programs are administered by the U.S. government, there are significant differences in the way these two programs function. The analysis of this paper will reveal the differences and describe the pros and cons attributed by the Medicaid system being administered separately by each state. Although Medicare and Medicaid both provide healthcare for U.S citizens, “Administratively, the biggest difference between Medicaid and Medicare is that states govern a lot of what Medicaid covers, while the federal government runs Medicare” (Caplinger, 2015). The rationale behind these variances is due to Medicaid being based on need and social welfare, whereas Medicare serves people who have reached retirement age or are disabled, regardless of their economic status. This disparity brings forth both advantages and disadvantages for individuals needing this healthcare assistance. …show more content…

As our textbook explains regarding Medicaid, “Because plans are administered at a state level, each state determines coverage and coverage limits and sets payment rates subject to federal guidelines established under Title XIX of the Social Security Act” (Valerius, 2016, p. 362). This enables each state not only with the capability to provide its residents with optional benefits aside from the mandatory federal benefits required by law, but also with the power to consider the cost of living and different income variations for its

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Over 28 million people in the world receive health insurance through the Medicare program (Gornick, n.d.). The medicare program was designed to operate throughout the nation with a set of uniformed benefits and cost-sharing requirements in the form of deductibles and coinsurance. However, over the years the program data indicated that the Medicare premiums and deductibles, benefits paid out varied significantly by state of residence of the beneficiary (Gornick, n.d.). These variations are due to part of the fact that reimbursements are based on local physicians' prices. Many policy analysts suggested that the geographic variations in Medicare reimbursements should be reduced (Gornick, n.d.).

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One of the author’s reasoning for how taking away ACA would affect Medicaid is back in 2016 legislation tried to step away from it, but former President Barack Obama repealed it because could eventually affect the lives of millions of people. The authors also cover how ACA changed Medicaid for the better, for example creating a program for just children’s coverage, inventing a new method to determine eligibility, and even creating new benefit options for families and small businesses. The author describes how the new Presidential administration can repeal or alter Medicaid through Section 1115. The authors main argument is that by repealing ACA would eliminate the Medicaid system which in turn will allow millions of people to be

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Although this is under Obamacare exchanges, it shows that state-run exchanges can effectively control the cost of premiums. A state that has efficiently and effectively controlled the health insurance markets is California. Through their state-run exchanges, California has managed to control the type and price of care provided by setting up a system that required all health insurers to provide the same deductibles and benefits within each of their coverage levels (Scheffler, Para. 7). Their plan is set up so that “insurers in all marketplaces must offer a defined set of “essential health benefits” in all plans and may offer plans at four coverage levels: platinum…followed in descending order of cost and coverage benefits by gold, silver, and bronze. ”(Scheffler, Para. 7)

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769 Words | 4 Pages

First, state taxpayers may experience rising healthcare costs disproportionate to other states (Mahan, 2). Without tailored federal assistance, health care costs may contribute to an unbalanced state budget that burdens the taxpayer. In order to account for this, states may be forced to eliminate certain programs, therefore, leaving some without coverage. Medicaid currently covers almost 70 million Americans, including one in three children, four in 10 births and 70 percent of nursing home residents (Kodjak, 2). With the implementation of block grants, especially without clear guidance and infrastructure, those currently covered by the Affordable Care Act could very well experience reduction or loss of their health coverage.

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627 Words | 3 Pages

The government of some opt out states are looking at alternative options to provide care for their large uninsured populations but this only leads to disparities in the health care options available to their denizens versus the other states (Omolola et.al). One proposal repeatedly made by the current administration is to limit the federal contribution by switching from the current percentage model to a model of block grants or per-capita caps. Under the block grants model, states would be given a fixed amount of Medicaid funding which they would need to manage. Under the per-capita model, Medicaid recipients will be subject to a reimbursement cap.

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Medicare Kelsey Reinholt SOC 400 10/22/2015 Les Lazarevic ABSTRACT The focus of this paper is to provide knowledge over the Medicare and its requirements. This paper explains some challenges that might occur with the choices on Traditional Medicare, with Medicare+Choice, there is usually an incentive financially or at least an encouragement for a transfer to the private sector for little to no cost. Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated.

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Today, President Trump, like President Reagan, is interested in transferring government spending on Medicaid and giving block grants to the states to control their own Medicaid programs. Many people, even some Republicans, are worried that the states, without much government intervention will cut people from the services they are receiving currently. The politicians who are in disagreement with this proposal strongly favor a more centralized government and cling tight to the original meaning of

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To help cover this expense, Medicaid, a critical government assistance program, provides medical coverage to those low-income individuals and families. This ensures that essential health services such as doctor visits, hospital stays, prescription drugs, and other services are available. Medicaid is intended to promote the overall well-being who would otherwise face significant financial challenges to accessing critical medical treatment, limiting their capacity to seek higher education and job progression. Medicaid assists employees in this by providing a healthcare safety

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The higher someone's value, the less they have to pay for bills. For instance, if someone's actuarial value is 60%, the insurer pays 60% of the medical bill and the insuree pays 40%. Medicaid is a U.S. health care program that provides free or low-cost health insurance to people who have low incomes. In 2014 Medicaid was expanded to cover people whose income did not exceed 138% of the federal poverty level (Stoltzfus and Pollack). However, states had the option to not expand their Medicaid system.

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The eligibility rules for Medicaid have been criticized as confusing. Medicaid is a state administered program and its rules vary across states. That can present a significant problem to someone enrolled in Medicaid that moves across state lines. The 2012 Patient Protection and Affordable Health Care Act (ACA) included some changes in Medicaid enrollment procedures. President Lyndon Johnson was responsible for the creation of Medicare and Medicaid in 1965 (Berkowitz, 2008).

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Medicaid and Medicare were signed into law in 1965. After 50 years, Medicare and Medicaid are still being used by the people of the United States as a form of aid with medical expenses. Medicare and Medicaid has changed over the years to provide more and more Americans with access to quality and affordable health care that is needed (“CMS’ program history,” 2017, p.1). Medicare and Medicaid have progressed over time to become better and more improved for those receiving the services provided by the government. Even though the Medicare and Medicaid services have changed for the better of the services, it has changed too much from the intended use of the services which has led to problems associated with the

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Eligibility is based on peoples’ income which is calculated related to a percentage of the Federal Poverty Level. Also, there are other non-financial eligibility criteria for example; individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship. Medical bills are paid from federal, state and local tax funds. The federal government funds up to fifty percent of the cost of each state's Medicaid program, with more rich states receiving less funding than less affluent states. Because of this federal/state corporation each state has its own rules and regulations about who is eligible and who is covered.

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482 Words | 2 Pages

Whereas more people are enrolling in Medicaid than Medicare, more executive orders of cutting Medicaid funds become common, while people who desperately need the assistance Medicaid gives them will become denied. Medicaid is a federal program that covers over 65 million people, those people being pregnant women, families and their children, the elderly, people with disabilities, and all people regardless of age who are near or under the federal poverty line. The largest group Medicaid covers is the elderly which are 10% of enrollees and ¼ of Medicaid spending. More than what Medicare, a federal health care program which only covers support block people of age 65 and over, spends. Federal law requires states to provide mandatory benefits

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743 Words | 3 Pages

States are being pressured to expand Medicaid to families earning up to $30,000 a year, just like the Affordable Care Act permits. While several respected governors have agreed to expand the program, many other governors and state legislators are cautious. These officials do not want to deny Americans their access to health care, however they do want to slow the expansion of a program that will provide them with limited access to quality care while destroying state budgets. One of the strongest arguments that can be made against the expansion of Medicaid is the fact that States simply can not afford it. The appeal to states to expand Medicaid is that the federal government will cover 100% of the cost through 2016 and eventually lowering to

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