Medicaid and Medicare

When all else fails, and if an individual lives long enough, a citizen of the United States eventually may qualify for one of the two publicly-funded insurance programs, known as Medicaid and Medicare. Although the two have similar names, they are quite different programs. Perhaps the one aspect they share is that few people know what the heck they are.

Both are the result of nearly a century of debate by American Presidents and Congress over the issue of health care insurance reform. Although these programs often are associated with social reforms pressed by President Franklin Roosevelt as part of his New Deal reforms during the Great Depression of the 1930s, the idea of national health insurance for all Americans was first advocated by another Roosevelt, President Theodore Roosevelt, prior to World War I.

Medicare

While government-funded social service programs date back to the Depression, the Federal Medicare program became part of the Social Security Act in 1965. It provides hospital benefits, supplementary medical care, and catastrophic coverage to persons 65 years of age and older and to some younger persons who are covered under Social Security benefits, notably those with permanent kidney failure.

It is the nation's largest health care program and is broken into two parts. "Medicare Part A" pertains to hospital insurance and helps pay for in-patient care in a hospital, skilled nursing facility, or psychiatric hospital. It also covers hospice and home health care. "Medicare Part B" pertains to medical insurance and pays for physician services and many other medical services and supplies not covered by Part A.

There is no premium for Part A because program participants or their spouses have paid Medicare taxes during the years they were working. Even if Medicare taxes were not paid, an individual might still be eligible to pay a premium for Part A benefits.

Medicaid

On the other hand, Medicaid is a program administered by individual states with federal matching funds and pertains to public health assistance for persons, regardless of age, whose income and resources are insufficient to pay for health care. This coverage is available for low income citizens, including families, children, elderly, and the disabled.

There are income requirements to qualify for Medicaid. Although the government and states fund Medicaid, states generally have authority to establish program rules, therefore Medicaid services and eligibility requirements vary from state to state. General coverage includes hospital services, physician services, lab and x-rays, home health care, and dental coverage for children.

The Medicaid program in recent years has been experiencing serious funding problems due to such problems as rising health care costs and a failing economy, which results in more individuals qualifying for coverage.

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