Medicare and Medicaid

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Medicare and Medicaid

Medicare is a program managed by the government to provide health coverage to people who are the age of over 65 years or people less than 65 years but living with disabilities. Medicare is made of two parts that are considered by the medical society as vital. The parts include Part A or hospital insurance (Bronchetti, & McInerney, 2017). The main duty of this hospital insurance is to settle pending hospital bills and stay together with other services. The second part is part B which is also known as the supplementary medical insurance. The main duty of part B is to cater for hospital services that are specific such as outpatient visits. Individuals living in the US as permanent residents for a minimum of five years are also legible to using Medicare. Individuals who have also worked to gain legibility for railway road retirement benefits or social security also qualify for Medicare. This case usually arises for individuals who have been able to earn more than forty credits for a working period of about 10 years. Government workers as well as the ones who have retired from the government and have not been able to make payments in social security but were able to make the payments on taxes on Medicare payroll during the working period also qualify for Medicare. On the other hand Medicaid is also a federal and a state program under the management of the government that provides people of any age with the medical insurance can have both Medicare and Medicaid if he/she is eligible, this will help in lowering the costs.

Medicare is very important because it provides the elderly with proper medicine and care but also you need to have a social security so as you can acquire the medical care. The Medicare and Medicaid programs have really helped many people especially the vulnerable groups. Pregnant women, children, chronically ill, prisoners and the elderly people are the ones considered vulnerable, and they are at high risk of a having poor as to help people with such conditions, the government should consider lowering the cost of acquiring the Medicare card.The government should consider providing the vulnerable people with Medicaid where the cover this will help them get medical assistance quickly. Pregnant women are at high risk of getting any infection, and it is important for them to have access to the medical insurance covers. Individuals, however, are legible to Medicare under the age of 65 if they have received entitlement to the disability of social security for a period of at least two years (Hung, Casey, and Moscovice, 2015). This period in most cases does not have to be consistent. If an individual under the age of 65 also happens to receive a pension from the Railroad retirement board due to some form of disability and can meet some conditions, he/she also qualify for Medicare. A person under this age who also happens to suffer from Lou Gehrig’s disease, i.e. the amyotrophic lateral sclerosis automatically qualifies for Medicare.  Individuals under the age of 65 who happen to suffer from kidney problems that are permanent and require certain medical attention like dialysis or transplant also automatically qualify. However, they are only legible if they happen to have made payments on the taxes of social security for a particular period.

A population that is regarded as vulnerable is the one that is made up of a group of individuals that are more likely to develop issues relating to their health. The individuals may also be experiencing difficulties in gaining access to adequate healthcare as well as medical cover. The qualification of being legible to Medicare as well as medic aid can be modified in various ways. Medical agencies together with the government should lower the rates, payments and even penalties incurred in hospital insurance as well as medical insurance. The vulnerable population on its self is fully defendant on some benefits and are somehow unable to meet some of their medical needs. By subsidizing the necessary hospital insurance and medical insurance fee or even assisting them pay at least some initial amount will enable a majority of the population benefit from the Medicare program.

Medicare is useful when it comes to medical billing. Since Medicaid and Medicare pay large volumes to the government, billers are tending to send out claims directly to them. It, therefore, means that billers do not necessarily have to undergo the process of house clearing for the applications they bring. The creation of Medicaid claims is more complicated as compared to the nature of the Medicare claims. Medicare varies across different states and so are its billing requirements and regulations. This being the case the formats and forms used by the medical biller tend to change and vary state wise. This is where Medicare becomes effective since the medical biller will be forced to confirm with their Medicare state program to be relevant to the protocols and forms adopted by the state. For the case of a payer having an insurance plan, the billing of the plan should precede Medicaid as well as Medicare since Medicaid and Medicare are the last service billers for a payment. When Medicare processes the part A of a claim, payments are directly made to the provider for the services offered. In the case of a part B claim, the one required to make payments depends on the one who has chosen to accept the assignment brought forth by the claim. In the case where the provider accepts the given assignment in the claim, eighty percent of the cost procedure is paid to the provider by Medicare and the twenty percent remaining is left and directed to the patient.

The eligibility and qualification to Medicare and Medicaid has been very beneficial to many vulnerable individuals living in contemporary society. Many vulnerable citizens are now able access medical services through subsidized hospital and medical insurance policies. Access to improved healthcare is of great importance to the vulnerable citizens since they will not have difficulties in accessing an improved health care system. The ability to put policies that permit individuals below the age of 65 is an excellent asset in realizing an improved healthcare system. These are the majority of the population in the US and improving their healthcare accessibility means ensuring that a majority of the US population stays healthy.4

The Affordable Care Act (ACA) is a healthcare and medical reform policy that put in action in March 2010. In the US it is commonly referred to as Obama care. It was majorly aimed at ensuring that at least all citizens have an access to medical insurance cover. It also aimed at making sure that the program for Medicaid is diversified as well as ensuring innovative and modern healthcare delivery methods (Natafgi, Nattinger, and Wolinsky, 2016). It has however had several impacts on Medicaid recipients as well as Medicare. It has ensured an increase in enrollment and outreach. It has assured that any citizen living in the US with various disability forms qualifies for services offered by medic aid. The ACA has made it possible for people to enroll with the Medicaid without necessarily having a defined level of income.




Bronchetti, E. T., & McInerney, M. (2017). Does increased access to health insurance impact claims for workers’ compensation? Evidence from Massachusetts health care reform.

Hung, P., Casey, M., & Moscovice, I. (2015). Critical Access Hospitals’ Receipt of Medicare and Medicaid Electronic Health Record Incentive Payments.

Natafgi, N., Nattinger, M., Ugwi, P., Ullrich, F., & Wolinsky, F. D. (2016). The impact of the affordable care Act (ACA) on favorable risk selection and Beneficiaries’ health status in Medicare advantage: a preliminary assessment. BMC health services research, 16(1), 404.