CEhle.HCA320.M8.docx - 1 Medicare Medicaid Courtney Ehle...

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1Medicare & MedicaidCourtney EhleAspen UniversityHCA 320: Healthcare Policy and EconomicsStacy Severin, RN, MSN10/12/20
2IntroductionMedicare began in 1966 under the Social Security Administration (SSA), now theCenters for Medicare and Medicaid Services (CMS). Medicare is a national health insuranceprogram that offers insurance, in general, to people who are 65 and older, persons withdisabilities and persons with end stage renal disease (requiring dialysis or awaiting a transplant)(CMS, n.d.). Medicaid is an insurance service provided by each state individually. In this paper,I will discuss Medicare and Medicaid benefits and how to qualify, how Medicare improves theirpolicies and why nurses should advocate for cost-effective insurance services for all. Medicare and Medicaid Benefits & QualificationsMedicare Qualifications and BenefitsIn general, people who are 65 and older, persons with disabilities and persons with endstage renal disease (requiring dialysis or awaiting a transplant) can qualify for Medicare.Disabilities are subject to approval through an application process. Once an individual canqualify for Medicare, there are multiple parts to the insurance program. Parts A, B, C, & D, withPart C being less utilized section. Part A covers inpatient hospital stays, skilled nursing facilities(only after being admitted for three days and that placement in the nursing home is not forcustodial care) and hospice services. Part B is for outpatient services such as outpatient hospitalcharges, most provider office visits and professionally administered prescription drugs. Part D isthe prescription drug program that covers the majority of self-administered drugs. Part C is analternative program called Medicare Advantage that allows for patients to choose private healthplans outside of Medicare A & B, that are approved by Medicare. These plans offer the sameservices as A & B, and usually have more coverage included like dental, vision and theprescription drug plan is lumped in there too (HHS, n.d.).
3Medicaid Qualifications and BenefitsMedicaid is a joint federal and state insurance program that provides coverage to millionsof Americans at the state level. In order to participate in the Medicaid program, states mustallow for certain high-risk populations to qualify. Some of the mandatory groups are low-income families, qualified pregnant women and children, and individuals who are receivingSupplemental Security Income (SSI). There are other groups that are optional for states to cover,such as individuals who are receiving home or community-based services or foster care childrenwho do not qualify otherwise. In 2010, the Affordable Care Act (ACA) provided an opportunityfor states to expand their eligibility requirements and allow for many low-income adults toqualify for Medicaid. With the ACA, there was a new methodology established for determiningfinancial eligibility for Medicaid, which is calculated on Modified Adjusted Gross Income(MAGI).

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