Medicaid vs. Medicare

Medicaid vs. Medicare



Medicaid vs. Medicare

The different frameworks that the Medicare and Medicaid health plans possess have led to disputing incentives in relation to particular aspects. In this respect, one of the factors comprises the presence of dual eligibility in recipients without managed care (Clark & Hulbert, 2008). The key interest of the respective healthcare plans involves the reduction of medical expenses. Nonetheless, both of the plans lack an incentive that caters to the quality of medical care services that are provided. On one hand, the Medicare scheme is organized by the national government. In this scheme, persons who can access the program mainly comprise those over the age of 65 regardless of their incomes (Grabowski, 2007). Additionally, young persons with physical impairments as well as those who can access the disability scheme set by Social Security are eligible for the respective scheme. On the other hand, the Medicaid scheme is organized by the state (Grabowski, 2007). The program caters to employees within any age who earn income by offering insurance cover.

One of the strengths evidenced between the Medicaid and Medicare involves the access that they provide to individuals for purposes of accessing dual eligibility. It is imperative to provide expansive acute and long-term services to beneficiaries of Medicare and Medicaid covers if they are dually eligible. However, a considerable weakness of the Medicare scheme is that it is incapable of offering covers for services such as transport, acute dental care, and vision services (Clark & Hulbert, 2008). Furthermore, the respective cover does not offer services related to the provision of long-term medical care. Medicare mainly focuses on the elderly populations and does not offer its services to persons who are under the age of 65. One of the weaknesses for the Medicaid involves the costs associated with implementing it in medical care facilities (Clark & Hulbert, 2008). Apparently, it is more expensive in comparison with Medicare. Furthermore, parents who are not married need to be financially poor or destitute in order to receive qualifications for Medicaid. Nevertheless, the services currently uncovered by Medicare undergo reimbursement via the Medicaid health scheme.

Medicare and Medicaid covers are the main ways in which considerable portions of the American population attains access towards medical care. Nonetheless, the Medicaid scheme is significantly towards the promotion of access to health care in comparison to Medicare. In 1960, the number of persons that enrolled the respective program comprised nearly 10 million American citizens. Interestingly, the number has increased consistently and presently, nearly 41 million persons maintain access to the respective program (Weeks, Berman, & Bisbee, 2011). Consequently, the minimal dedication by the Medicare service is due to the unavailability of opportunities that will allow for the extension of eligibility prerequisites since the 1970s. One perfect illustration of the Medicaid expansion scheme that has influenced increased accessibility towards medical care services comprises the State Children’s Health Insurance scheme (Short & Fox, 2002). The respective scheme offers insurance coverage to children who come from families with low incomes.

With the constant rising expenses in healthcare, both Medicaid and Medicare health schemes are trying to institute a balance between the regulation of costs and the expansion of access to healthcare services. One similarity between the respective schemes involves government financing. Accordingly, the Medicare and Medicaid schemes are financed by the federal government (Holahan & McMorrow, 2012). Because of this, both schemes operate in a joint operation aimed at providing healthcare covers to the elderly and poor populations. Such covers are unique since they focus on minimizing the costs that these populaces incur upon the attainment of healthcare services. The risk of cost growth is a particularly imperative consumer risk that is associated with the Medicaid and Medicare schemes. Additionally, insufficient healthcare services comprise consumer risks that are mainly evident in Medicaid covers.

Aside from this, the consistent increase in the number of covered patients coerces the need to supply more doctors. As such, there are insufficient primary care physicians presently. The care plans advocated for by the Medicaid cover discourage doctors within most of the country’s states. Therefore, it is usual for persons secured by Medicaid to assert insufficient health conditions in comparison to those that are uninsured as well as those that are safeguarded by private healthcare schemes. One of the traits that is associated with the Medicare scheme involves the limitation of physicians from the attainment of healthcare reimbursements that are more in relation to the amount of payments reimbursed by Medicare recipients (Rosenthal, (2011). Therefore, it is not shocking to find certain doctors refusing to offer healthcare services to persons covered by the Medicare plan because of the less amount issued by the scheme which tend to be lesser than the incurred expenses.

In conclusion, one of the main recommendations for the Medicare cover involves the extension of its insurance cover, eligibility prerequisites, and access. Presently, persons that are 65 years and above are the only ones capable of gaining access to the program. Hence, an inclusion of the total population would endorse significant accessibility towards the healthcare services provided by the state. Another recommendation involves the reduction in expenditures characterizing the Medicare scheme. Implementation of measures aligned to cost efficiency will allow for the reduction of expenses comprising the access to healthcare for most insured patients. Lastly, it would be advisable for the Medicare health plan to extend the scope of the services it provides to its recipients. Healthcare services that last for a long-term period as well as other services such as transport can be included and provided.


Clark, W. D., & Hulbert, M. M. (2008). Dually eligible Medicare and Medicaid beneficiaries, challenges, and opportunities. Health Care Financing Review, 20(2), 1-10.

Grabowski, D. C. (2007). Medicare and Medicaid: Conflicting incentives for long-term care. Milbank Quarterly, 85(4), 579-610.

Holahan, J., & McMorrow, S. (2012). Medicare and Medicaid spending trends and the deficit debate. The New England Journal of Medicine, 367(5), 393-395.

Rosenthal, M. B. (2011). Hard choices–alternatives for reining in Medicare and Medicaid spending. The New England Journal of Medicine, 364(20), 1887-1890.

Short, P., & Fox, M. (2002). Similarities and differences in choosing health plans. Medical Care, 40(4), 289-302.

Weeks, L. E., Berman, H. J., & Bisbee, G. E. (2011). Financing of health care. Ann Arbor, MI: Health Administration Press.

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