Medicare & Medicaid (Essay Sample)

Medicare & Medicaid Student’s Name Institutional Affiliation Course Number: Course Title Instructor’s Name Assignment Due Date Medicare & Medicaid Introduction Medicare and Medicaid programs were launched to address the deteriorating health of the Great Depression's aging population. Deaths covered by Medicaid and Medicare in 1965 represent an important health unit in the postwar era. These medical-related governmental programs receive funding from a wide range of government entities and benefit people from all walks of life. Although they share similar goals regarding health care coverage, Medicare and Medicaid are actually two separate systems. Medicaid is a federal health insurance program which serves less income Americans of all ages and their families. This health insurance plan serves all adults, minors, pregnant mothers, and those with disabilities who qualify for coverage. Through the efforts of CHIP and Medicaid, nearly 7,000 people now have health insurance. The program's primary focus is on treatment, but it also serves as a key source of health insurance for Americans. There is no maximum age requirement for coverage of disabled individuals. This paper will look at the requirements for receiving Medicaid and Medicare, as well as measures that might be modified to provide more assistance to those who need it. Medicare and Medicaid eligibility requirements are different in each state. Medicare, however, is a government-run health insurance program for seniors 65 and above. Describe the Quality Improvement Organization (QIO) and explain how the QIO improves policies and healthcare for Medicare beneficiaries. QIOs are crucial in helping hospitals, nursing homes, and other providers implement improvements that improve the quality, safety, continuity, and accessibility of medical treatment for their patients. The Quality Innovation Network and Beneficiary and Family Centered Care QIOs are the two main categories of QIOs in this initiative (Yu, & Sonnenfeld, 2019). The QIO is a major government initiative with the goal of improving the quality of Medicare beneficiaries' access to health care in their local communities. It's essentially a place where consumers may voice dissatisfaction with a company's service, file appeals against billing and coverage choices, and so on. The mission of BFCC-QIOs is to facilitate Medicare recipients' access to, and use of, high-quality healthcare. QIO also targets to lower the prevalence of chronic diseases in the society it serves. Review, complaints, and appeals from Medicare recipients are all handled by the QIO. There is one BFCC-QIO per service area. QIN-QIOs, on the other hand, collaborate with healthcare providers and community members to boost patient safety, engage patients and their families, reduce adverse events, and enhance the quality of clinical treatment. Qualifications for Medicare and Medicaid benefits When applying for Medicaid, applicants must submit a written request that meets certain requirements. Medicare has different requirements than Medicaid does, and Medicaid requires a formal request to the state for first authorization. Additional coverage alternatives have been made available in several states. Those who do not belong to the qualified categories cannot get coverage under this health plan. Low-income families, children, pregnant women, and persons receiving disability payments in addition to their regular Social Security benefits are the primary targets for Medicaid expansion. A person's Medicaid eligibility is calculated using their MAGI-modified. Medicaid eligibility is also determined by a person's ability to pay for medical care. The disabled, the blind, and the elderly are among those who do not meet the MAGI-based financial requirements. To determine financial aid eligibility, MAGI takes into account taxable income. Medicaid recipients' financial eligibility is also often determined by their tax return relationships. This necessitates that an individual be either lawfully present in the country or a permanent resident. Medicaid recipients are also determined by other factors than income. For instance, individuals must be residents of a state with Medicaid coverage. Medicaid recipients' other eligibility criteria are also based on life events such as pregnancy, fatherhood, and age. Medicare Eligibility Requirement To qualify, a person must be at least 65 years old, which is one of the primary conditions (Moon, & Uccello, 2020). People who want to receive services from Medicare must, just like those who want to get services from Medicaid, satisfy certain requirements. The recipient must also be eligible for the social security retirement benefit and hold a public post in order to receive the payment. Additionally, the spouse or beneficiary must have participated in the Medicare system by paying Medicare payroll taxes while they were employed. Another one of the prerequisites is that the individual must have lived in the United States continuously for at least five years as a permanent resident. Those who have accrued 40 credits via payroll taxes are ineligible for a Part A reward (Moon, & Uccello, 2020). The Social Security Administration should not have been paid. The first requirement is that the individual has been qualified for Social Security payments for a minimum of two years. Patients with chronic renal illness and who need long-term dialysis or transplantation may also be eligible for Medicaid coverage. In certain cases, those under the age of 65 may also be eligible. You may have also qualified for a disability pension from the Railway Withdrawal Council. Paying the monthly charges for both Part B and Part D provides the insured with the same comprehensive coverage. Note that if you apply for Medicare Part B, you will not be eligible for Medicare Part A. To be eligible for Part A, however, you must also enroll in Part B. Over-65s who do not satisfy the other requirements but who consistently pay their Part A payments may be granted eligibility. In particular, those with 30 credits or less are eligible for premium payments of US dollars 430 and below. How can qualifications be modified to serve more people who are considered a vulnerable population? Health issues are more prevalent among the disadvantaged population because of the difficulty they have in receiving adequate medical treatment. Individuals in at-risk groups would benefit from having access to healthcare if Medicaid and Medicare were expanded. The Medicare eligibility age has to be lowered from the current 65 to the more reasonable 55. That's why it's important to include quality standards into all forms of health insurance. Health care costs for this population might be reduced by expanding this group. This means that private insurance companies will provide cheaper rates for new families. The expansion of this category would provide protection for at-risk seniors over the age of 65. More individuals are able to qualify for Medicaid and Medicare due to the cost limits that assist lower the amount of premiums, direct charges, and deductions. Cost caps should be implemented, and universal health care coverage should be encouraged, so that everyone, not just those most in need, may be cared for. Immigrants and members of other marginalized groups would benefit greatly from this since they would be eligible for health insurance. The federal government should think about offering Medicare-eligible patients access to universal quality models. The criteria for inclusion must include those with numerous chronic diseases. Financial support for health insurance must be a requirement for Medicare eligibility in order to offer disadvantaged populations with excellent health care. By making these changes to both programs, poor populations will have more access to healthcare. More than two hundred thousand people who identify as LGBT would now be eligible under the new expansion. In addition, there is a need to revise the criteria to include those with incomes below 138 percent of the state poverty threshold. The government should also make an effort to keep the nondiscrimination clause in the Responsible Care Act intact. It has been shown that the LGBT population confronts substantial prejudice in health care, which makes it difficult for them to get high-quality treatment (Nealy, 2017). Further, these initiatives would help racially marginalized and economically underprivileged communities, such as those comprised of African Americans. Extending the Affordable Care Act (ACA) to the wealthy is therefore another necessary adjustment. Some states have embraced ACA plans to expand Medicaid and the Marketplace to cover these individuals, while others have not. Houston and Atlanta are examples of states that are slow to establish such programs, which limits minority access to medical care. ACA Impacts on the Benefits and Coverage for Medicare and Medicaid Receipts The Affordable Care Act's (ACA) primary goal was to increase health insurance coverage while also enhancing patient access to care and decreasing discrimination against those in need of medical attention. The goal of the Affordable Care Act is to make it easier for Americans to get health insurance. ACA Increased access to treatment, preventative health examinations, better health, less usage of emergency services, and decreased probability of late service are only some of the good health outcomes linked with Medicaid coverage. Infant, child, and adult mortality rates (Mazurenko et al., 2018). Without prejudice, the ACA ensures access to care that is both of high quality and culturally competent. Although the ACA has provided several benefits to Americans, certain concerns must be addressed to increase access to health care, including heavy financial penalties for those without coverage and smaller networks. The Patient Protection and Accessibility Act incorporates variou...