Wednesday, November 5, 2014

Medicare vs Medicaid

Image result for medicare image

While many readers of this blog will be familiar with Medicare vs Medicaid, some might still have confusion on the similarities and differences of the two.  Both are government funded health assistance programs, but that is generally where the similarities end.

Medicare is a federally sponsored program that provides healthcare coverage for adults 65 years of age and older, as well as some adults younger than 65 years with certain disabilities or end-stage renal failure.  Medicare is divided into several parts:
            Part A – helps cover the cost of inpatient care in hospitals, skilled nursing facilities, hospice, and home health care.  This coverage generally comes at no cost to the patient because the patient and/or the patient’s spouse has already contributed income tax dollars toward the Medicare program.
            Part B – covers other doctor expenses, including some preventative care, medical equipment, and rehabilitation services.  There is usually a monthly premium associated with Part B.
            Parts C and D – optional, additional coverage, including prescription drugs.

Medicaid provides assistance to low-income individuals and families to pay for health care.  The funding for Medicaid comes from your federal tax dollars, but the state governments choose who qualifies and how to distribute the coverage.  The Affordable Care Act has encouraged some states to expand their Medicaid programs to include more individuals who do not have insurance coverage through their employer and cannot afford individual coverage.

It is important to note that a physician is not required to accept Medicare or Medicaid payments.  If a physician does not accept payments from government-funded programs, then a patient must either pay out of pocket for the service or seek another healthcare provider.  Providers may choose not to accept these payments because they feel the reimbursement rate is too low.  Some medical providers may be prevented from accepting Medicare or Medicaid payment because they have been penalized for fraudulent activity or do not meet certain safety regulations monitored by such agencies as the Joint Commission.

For more information, please see this helpful video from Khan Academy:

Valerie J Connor, MA CCC-SLP


Stanford, C. C., & Connor, V. J. (2014). Ethics for Health Professionals.  Burlington, MA: Jones and Bartlett Learning.


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