Medicare and Medicaid Act
Medicare and Medicaid are U.S. government-sponsored programs designed to help cover healthcare costs for American citizens. Established in 1965 and funded by taxpayers, these two programs have similar-sounding names, which can trigger confusion about how they work and the coverage they provide.
Medicare provides medical coverage for many people age 65 and older and those with a disability. Eligibility for Medicare has nothing to do with income level. Medicaid is designed for people with limited income and is often a program of last resort for those without access to other resources.
Part A: Hospitalization Coverage
Medicare Part A provides hospitalization coverage to individuals who are 65 years or older, regardless of income. To qualify, you or your spouse must have worked and paid Medicare taxes for at least 10 years. Most people dont pay a premium for Part A, but deductibles and coinsurance apply.
Part B: Medical Insurance
Those eligible for Medicare Part A also qualify for Part B, which covers medically necessary services and equipment. This includes doctor’s office visits, lab work, x-rays, wheelchairs, walkers, and outpatient surgeries, as well as preventive services such as disease screenings and flu shots.
Part C: Medicare Advantage Plans
Individuals who are eligible for Medicare Part A and Part B are likewise eligible for Part C, also known as
Medicare Advantage. Medicare Part C plans are offered by private companies approved by Medicare.
Part D: Prescription Drug Coverage
Medicare Part D provides prescription drug coverage. Participants pay for Part D plans out-of-pocket, and must pay monthly premiums, a yearly deductible, and copayments for certain prescriptions. Those enrolled in Medicare Part C will only want to consider Part D if their plan has no prescription drug coverage.
A Medicare bill had received the endorsement of President John F.
Kennedy, and a long campaign for its congressional passage began. By now, the idea of national health insurance had undergone, if not
another transformation, then at least a major change in an effort to
find common ground with private health care providers. Wilbur
Cohen, who coordinated the legislative activities related to Medicare for Presidents Kennedy and Johnson, expressed what the legislation would not do, rather than what it would do. Cohen (1961) said that the proposal would “… not provide a single medical service, physicians services would not be covered or affected and the proposal provides that the government would exercise no supervision or control over the administration or operation of participating institutions or agencies.” Beyond the political expediency of restricting benefits to the elderly and concentrating on hospital, rather than physician care, the limits that Cohen set on Medicare reflected the increasing prominence of the hospital as a provider of medical care.
Medicaid is a joint federal and state program that helps low-income Americans of all ages pay for the costs associated with medical and long-term custodial care. Children who need low-cost care but whose families earn too much to qualify for Medicaid, are covered through the Children's Health Insurance Program (CHIP), which has its own set of rules and requirements. The federal/state partnership results in different Medicaid programs for each state. Through the Affordable Care Act (ACA), which was signed into law in 2010, President Barack Obama attempted to expand healthcare coverage to more Americans. As a result, all legal residents and citizens of the United States with incomes of up to 138% of the poverty line qualify for coverage in Medicaid participating states.
Those covered by Medicaid pay nothing for covered services. Unlike Medicare, which is available to nearly every American of 65 years and over, Medicaid has strict eligibility requirements that vary by state. However, because the program is designed to help the poor, many states require Medicaid recipients to have no more than a few thousand dollars in liquid assets in order to participate. There are also income restrictions.