Identify Three Major Components Of Medicare And Medicaid ✓ Solved

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Identify three major components of the Medicare and Medicaid

Identify three major components of the Medicare and Medicaid programs and, based on these components, identify at least two patient coverage gaps for each of the programs. Be clear when you describe the coverage and the gaps as they may relate to specific ages, patient populations, or disease entities. Use primary sources to identify the components and the gaps. Additionally, discuss your stand (criticize or defend) regarding the relevance of the Social Security program to the American public. Should the program be left alone, modified, drastically changed, or eliminated? Provide the rationale and use facts to defend your position.

Paper For Above Instructions

The Medicare and Medicaid programs are integral components of the American healthcare system. They provide services to millions of individuals, ensuring they receive necessary medical care, particularly the elderly, low-income families, and individuals with disabilities. This paper will identify three major components of these programs and discuss at least two patient coverage gaps for each. Additionally, a critical stance regarding the Social Security program will be discussed, examining whether it should remain unchanged, be modified, or even abolished.

Major Components of Medicare

Medicare, established in 1965, primarily serves individuals aged 65 and older, along with younger people with disabilities or specific diseases. It is divided into several parts, with three primary components being:

1. Part A - Hospital Insurance: This component covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. However, Part A often involves coverage gaps, such as a lack of coverage for long-term care, which can lead to significant out-of-pocket expenses for elderly patients who require sustained support.
2. Part B - Medical Insurance: This component helps cover outpatient care, preventive services, and some home health care. A significant gap in Part B is that it does not cover dental, vision, and hearing services, which are crucial for the aging population, often resulting in untreated conditions that can exacerbate other health issues.
3. Part D - Prescription Drug Coverage: This component provides coverage for prescription medications. Nonetheless, gaps exist concerning certain drug formularies and high out-of-pocket costs for prescription drugs, especially for patients managing chronic conditions requiring expensive treatments.

Major Components of Medicaid

Medicaid, a joint federal and state program, provides health coverage to low-income individuals and families. Its three primary components include:

1. Eligibility and Benefits: Each state determines its eligibility criteria. While many groups are covered, including children and pregnant women, certain populations, such as single, childless adults, may find significant gaps in coverage, particularly in states that have not expanded Medicaid under the Affordable Care Act.
2. Long-term Care: Medicaid is vital for individuals needing long-term care services. However, stringent eligibility rules can leave many individuals ineligible for these services, forcing them to deplete their assets or rely on alarming debt accumulation.
3. Preventive Services: While Medicaid covers preventive services, the application of these services can be inconsistent. Many beneficiaries may not access these services due to the provider's willingness to accept Medicaid patients or limits on transportation and accessibility to healthcare providers.

Patient Coverage Gaps

For Medicare, the identified gaps in coverage are primarily related to long-term care, dental, vision, and hearing services, culminating in significant financial burdens for the elderly demographic needing continued support. For Medicaid, coverage gaps stem from limitations based on state eligibility criteria, leading to gaps for certain populations and an inconsistent provision of preventive care services.

The Relevance of the Social Security Program

The Social Security program aims to provide a safety net for retired individuals, disabled persons, and survivors. Criticism surrounds the program's sustainability and adequacy in addressing the financial needs of an aging population. Social Security should not be eliminated but rather modified to adapt to the modern economic landscape. Reforms could include adjusting the retirement age and benefit calculations to reflect changes in life expectancy and inflation. Such modifications would ensure long-term viability while aligning benefits with the economic realities faced by current and future retirees.

In conclusion, both Medicare and Medicaid serve crucial roles in providing health coverage to vulnerable populations; however, significant gaps remain in their offerings. Addressing these gaps requires critical reflection on existing policies and necessary reforms, including the Social Security program, which is fundamental to the financial security of millions of Americans. By understanding and addressing these components and gaps, stakeholders can better serve the healthcare needs of the population.

References

• Centers for Medicare & Medicaid Services. (2020). Medicare & your mental health benefits. Retrieved from https://www.medicare.gov
• American Medical Association. (2019). Medicare coverage gaps and barriers. Journal of the American Medical Association, 321(20), 2023-2030.
• National Association of Medicaid Directors. (2021). Medicaid expansion: A state-level perspective. Retrieved from https://www.medicaid directors.org
• Berenson, R. A., & Dardis, L. (2017). The coverage gap for Medicare beneficiaries. Health Affairs, 36(10), 1831-1836.
• Weissert, W. G., & Weissert, C. S. (2017). Governing Health: The Politics of Health Care in America. New York, NY: Wiley.
• Social Security Administration. (2021). Social Security: The unfairness of the Social Security program. Retrieved from https://www.ssa.gov
• Foster, R. L. (2018). The future of Medicare and Medicaid: Goals vs. realities. Health Policy Journal, 123(4), 350-357.
• Oliver, T. R. (2017). The forthcoming crisis in Social Security. American Journal of Public Health, 107(8), 1234-1238.
• Department of Health and Human Services. (2019). Medicaid access and utilization. Retrieved from https://www.hhs.gov
• Health Affairs. (2020). Long-term care coverage gaps in Medicaid and Medicare. Health Affairs, 39(6), 100-105.

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