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Free «Medicare and Medicaid Managed Care» Essay Sample

The provision of health related services and medical attention to particular set of individuals in the United States is achieved through two outlined Medicare and Medicaid programs. The two programs are supervised by the Medicaid and Medicare Services centres, a U.S. Subdivision of Human and Health Services, though the two programs are very diverse. The social insurance course covering approximately forty four million people as of 2008 is known as Medicare. This program caters for about 3.2 percent of GDP.On the other hand, the social safety plan that covers nearly forty million people is the Medicaid Managed Care. This care accounts for virtually 2.4 percent of the GDP. These two programs were initiated when modifications were made on 30th July 1965 to the Social Security Act which was signed by President Lyndon Johnson (Moore & Smith, 2010).

Engel (2006) defines Medicaid Managed Care as a state governed course with medical and health tested services that cover families and individuals who have minimal resources and a low income. The principal supervision of the program is carried out at the federal state level. The individual states oversees its own programs, establishes the duration, type, volume and range of services, lays down the payment rates and institutes its principles of eligibility. There are fundamental services provided by the Medicaid Managed Care that cuts across all the individual states. These include: prenatal care, x-ray and laboratory services, supplies and services for family planning, child vaccines, inpatient and outpatient services, rural health clinics and midwife services.



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According to Rowell & Green (2005), the provision of optional services is also allowed and the states will still receive the Federal funds. Some of the permitted services include: transportation, physical therapy and rehabilitation, clinic and diagnostic services, nursing facility for children and facilities offering intermediate care for the mentally retarded. The sole determinant of eligibility to such services is the individual state with the Medicaid Managed Care. The state sets out its guidelines to ensure it targets the correct group the program is meant for. The main target group is the low-income earners though eligibility may vary depending on disability status, citizenship, age and pregnancy. Consequently, the state may provide Medicaid Services to the blind, infants below age one and institutional individuals with low-income. The administration of such services should be guided by the general outlined fundamental courses put out so that the state can receive federal funds.

However, Medicaid Managed Care does not entirely cater for unfortunate persons, as approximately sixty percent of poor people in America are not included in this program. The expenses incurred in Medicaid Care are catered for by a program that delivers payments to the providers of the health service. An accord for fee-for-service or measures for prepayment, such as organizations for health maintenance, form the basis of payments made by the states. The federal government in turn reimburses each state for their expenditures. Coinsurance, nominal deductibles or copayments for specific services on Medicaid beneficiaries may be enforced by the states. Nevertheless, family planning and emergency services offered by the institutions should not be liable to all the Medicaid beneficiaries. Politics play a central role on the operations of Medicaid Care as it affects the Federal State’s affairs, especially funds, which is very key to the states with this Medicaid Care (Moore & Smith, 2010).

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On the other hand, Medicare is an insurance program of the federal government that caters for medical and hospital services for particular disabled persons and the elderly (Engel, 2006). The composition of the program includes two major components and another two supplementary portions to offer prescription drugs and flexibility. The first part, Insurance for Hospitals, accommodates pays such as supplies, meals and testing. It further takes care of health care at home such as occupational, speech and physical therapy that are believed to be essential medical services. This part does not mainly involve the paying of monthly premiums as the costs are cared for by the payroll dues. The second portion is the Supplementary Medical Insurance which is concerned with outpatient visits, physician visits and home care expenses. This fraction covers blood transfusions, chemotherapy, transportation and outpatient procedures. Accordingly, monthly payments and yearly deductibles should be cleared prior to services coverage.

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The third part is the Medicare Advantage Plans, which enables the utilization of designed custom plan that can relate to the medical needs of the individuals. The provision of services can be done by private insurance companies, though particulars range with regard to the patient’s eligibility and program. The last part is the Medicare Part D, which entails compensation of deductible and premium prices. The individuals who are eligible to Medicare are those that have attained the age of 65 years, the disabled and below 65 years or those with a kidney failure that is permanent, necessitating a transplant or dialysis and must be a citizen of the U.S. having social security remunerations with costs into the system having been made for a minimum of ten years (Rowell & Green, 2005).

The Medicare expenses are catered for by taxes from the Federal Insurance Contributions Act and the Act of Self-Employment Contributions. The employer and the employee both contribute towards the payment of taxes which are put in a trust fund where the government makes payments to hospitals, private insurance companies and doctors. Deductibles, premiums and coinsurance contribute extra funds to the Medicare Services kitty. Since much of the running of Medicare depends on funding from the federal government, political stability is key to its existence and efficiency. The policies governing tax collection and remuneration as defined by the federal government also affect the running of the Medicare Services.


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