Medicare and Medicaid

Medicare and Medicaid
U.S. government programs in effect since 1966.

Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. Part B, a supplementary plan, pays for doctors' services, tests, and other services. Requirements and benefits are complex. Patients pay deductibles and copayments. Medicaid, a joint federal-state program, covers low-income people under age 65 and those who have exhausted Medicare benefits. It pays for hospital care, doctors' services, nursing-home care, home health services, family planning, and screening. Participating states must offer Medicaid to all persons on public assistance but decide their own eligibility guidelines. Many physicians refuse to treat Medicaid patients because of low reimbursement levels.

* * *

▪ United States health insurance
      two U.S. government programs that guarantee health insurance for the elderly and the poor, respectively. They were formally enacted in 1965 as amendments (Titles XVIII and XIX, respectively) to the Social Security Act (1935) and went into effect in 1966.

      The Medicare program covers most persons aged 65 or older and consists of two related health insurance plans: a hospital insurance plan (called Part A) and a supplementary medical insurance plan (Part B). The hospital plan, which is financed through Social Security payroll taxes, helps pay the cost of inpatient hospital care, skilled nursing home care, and certain home health services. The plan meets most of the cost of hospital bills for up to 90 days for each episode of illness. (An episode of illness is termed a “benefit period” and lasts from a patient's admittance to a hospital or nursing facility until he has been out of such facilities for 60 consecutive days.) The patient must pay a one-time fee called a deductible for hospital care for the first 60 days in a benefit period, and an additional, daily fee called a co-payment for hospital care for the following 30 days; Medicare covers the rest of the expenses.

      The hospital plan also pays for skilled care in a nursing care facility for 100 days if such care follows a period of hospitalization within 30 days. This nursing care is free for the first 20 days after hospitalization, with the patient required to make a co-payment for any of the next 80 days. A person is thus eligible for 90 days of hospitalization and 100 days of nursing care in any benefit period. In addition, home health visits by nurses or medical technicians are covered by Medicare, as is hospice care for the terminally ill.

      A patient becomes eligible for Medicare benefits again anytime he has gone for 60 consecutive days without receiving skilled care in a hospital or nursing facility; his reentry into such a facility marks the start of a new benefit period. In addition, each person has a “lifetime reserve” of 60 more hospital days that can be used at any time (including times when the 90 days covered in a benefit period have been exhausted), though a sizable co-payment is required.

      Medicare's supplementary medical insurance plan supplements the benefits provided by the hospital plan and is available to most persons 65 years or older. Persons who enroll in the plan pay a small deductible for any medical costs incurred above that amount and then pay a regular monthly premium. If these requirements are met, Medicare pays 80 percent of any bills incurred for physicians' and surgeons' services, diagnostic and laboratory tests, and other services. Almost all people entitled to the hospital plan also enroll in the supplementary medical plan. The latter is financed by general tax revenues and members' payments.

      The legislation enacting Medicare was passed in 1965 under the administration of President Lyndon B. Johnson (Johnson, Lyndon B.) and represented the culmination of a 20-year legislative debate over a program originally sponsored by President Harry S. Truman (Truman, Harry S.). Amendments to the program passed in 1972 extended coverage to long-term disabled persons and those suffering from chronic kidney disease. The program's rapid and unanticipated growth spurred the federal government to legislate various cost-containment measures beginning in the 1970s, notably one in 1983 that set standard payments for the care of patients with a particular diagnosis.

      Medicaid is a health insurance program established for low-income persons under age 65 and persons over that age who have exhausted their Medicare benefits. The program is jointly funded by the federal government and the states. To participate in the plan, states are required to offer Medicaid to all persons on public assistance. Aside from this, and within broad federal guidelines, the individual states determine the eligibility guidelines for enrollment in their own programs, with Medicaid generally offered to persons whose incomes and assets fall below a certain level. The federal government pays the states from 50 to about 80 percent of their Medicaid costs. Hospital care, physicians' services, skilled nursing facility care, home health services, family planning, and diagnostic screening are covered by the plan.

      Like Medicare, Medicaid quickly grew larger than originally expected, and in 1972 the federal government instituted the first of several sets of cost-containment measures in an effort to reduce the program's expenditures. From the early 1980s, increasing numbers of physicians refused to treat Medicaid patients because of the low reimbursement levels involved.

* * *


Universalium. 2010.

Игры ⚽ Нужно сделать НИР?

Look at other dictionaries:

  • Medicare and Medicaid Extenders Act of 2010 — Full title Medicare and Medicaid Extenders Act of 2010 Enacted by the 111th United States Congress Citations Public Law …   Wikipedia

  • Medicare And Medicaid Fraud — Illegal practices aimed at getting unfairly high payouts from government funded healthcare programs. There are many types of Medicare and Medicaid fraud, including billing for services that weren t provided (phantom billing, upcoding), performing …   Investment dictionary

  • Centers for Medicare and Medicaid Services — overview Formed 1977 (1977 MM) Preceding Health Care Financing Administration (1977 2001) Headqua …   Wikipedia

  • Medicare dual eligible — Medicare dual eligibles, in the Medicare system of the United States, are Medicare Part A and/or B recipients who either [1] qualify for a Medicare Savings Programs (MSP) or [2] qualify for Medicaid benefits. Dual eligibles generally qualify for… …   Wikipedia

  • Medicaid — est un programme créé aux États Unis qui a pour but de fournir une assurance maladie aux individus et aux familles à faible revenu et ressource[1]. Il est géré par les États qui le subventionnent conjointement avec le gouvernement fédéral. Parmi… …   Wikipédia en Français

  • Medicaid — Medicaid, (Medical Assistance), ist ein Gesundheitsfürsorgeprogramm in den USA, das die Bundesstaaten organisieren und Bundesstaat und Bundesregierung paritätisch finanzieren. Die Mischfinanzierung ist so festgelegt, dass der Bund 50 bis 80… …   Deutsch Wikipedia

  • Medicare Prescription Drug, Improvement, and Modernization Act — Acronym Medicare Modernization Act or MMA Citations Codification …   Wikipedia

  • Medicaid managed care — provides for the delivery of Medicaid health benefits and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – “capitation” – for these… …   Wikipedia

  • Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 — Full title Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 Acronym Balanced Budget Refinement Act or BBRA Enacted by the 106th United States Congress …   Wikipedia

  • Medicaid estate recovery — is the process initiated by U.S. state governments for recovering payments they made under the Medicaid program to program beneficiaries. The government recovers the sum of payments from the estate at the time of death of the program beneficiary …   Wikipedia

Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”