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Running head: MEDICARE AND MEDICAID 1 Distinguishing Medicare and Medicaid Lori L. Buckley Purdue University Global Dr. Jo Ann Wegmann November 27, 2018
MEDICARE AND MEDICAID 2 Medicare and Medicaid have distinguishing factors. According to Long (2005), many of the factors that influence commercial plans’ decisions to exit Medicaid are within the control of state policymakers and program administrators, including capitation rates, service carve-outs, mandatory enrollment policies, and the number of Medicaid enrollees and areas served by the plan [Lon05] . Medicare Advantage plans are required to include a specified number of physicians for each of 26 medical specialties, plus chiropractic care, along with hospitals, and other providers within a particular driving time and distance of enrollees in order to ensure that Medicare Advantage enrollees have access to the physicians that they may need [Sta18]. In the rural areas of the United States there are issues with access to specialty care providers. The driving time for some can be hours round trip. For example, in rural Alabama driving time to a hospital facility housing numerous specialty provider could be a two-hour drive time one-way. With this four-hour round trip, not including the office visit, testing, or multi-specialist appointments this is an all-day event. History of Medicare Private healthcare insurance programs and Health Maintenance Organizations (HMOs), began in the 1970’s. There are different names or schematics for each plan and coverage can be based on age and state of residence. Since 2006, Medicare has paid plans under a bidding process. Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted. The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs), [Fou18]. This system is difficult to understand.

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