Medicare and Medicaid: Components and Coverage Gaps
Major Components of Medicare
Medicare is a health insurance program financed by the federal government for people who are 65 years and above or those who have certain disabilities or terminal illness, such as end-stage renal disease. Medicare has three main parts: A, B, and D. Medicare Part A, also known as hospital insurance, helps pay for hospitalization, skilled nursing facility care, hospice care, and some home health services (El-Nahal, 2020). It does not, however, offer coverage for long-term care in custodial facilities. Medicare Part B or medical insurance covers outpatient services, preventive care, durable medical equipment, and physician services. However, it does not extend to dental, vision, or hearing services. Medicare Part D is the prescription drug coverage plan that aims to assist in paying for medications. However, it has the “donut hole”, which raises the beneficiaries’ out-of-pocket costs.

Coverage Gaps in Medicare
It is crucial to note that Medicare has gaps in coverage. First, it does not include the long-term care services that are more common among elderly patients who need a long-term stay in the nursing home. This gap means that many of the beneficiaries exhaust all their financial resources before they can access Medicaid. Second, Medicare does not cover some important services like dental, vision, and hearing services, leaving the elderly open to developing complications of diseases that would otherwise be treatable (Simon & Alpert, 2023). It also has the previously noted donut hole that increases out-of-pocket costs. These gaps put more financial and health risks on beneficiaries who are forced to seek different coverage or rely on self-funding for services.

Major Components of Medicaid
Medicaid is a federal and state-funded program aimed at offering health care access to low-income individuals and families, pregnant women, children, the elderly, and disabled persons. Three key aspects determine the coverage and the services offered under Medicaid. The first is the mandatory benefits of hospital, physician, nursing facility, and home health services (Donohue et al., 2022). These benefits help guarantee that the vulnerable groups in society get the required health care services. The second category is the optional services, which depend on the state and may include prescription drugs, dental services, vision care, and rehabilitative services. Since states define the extent of these benefits, the ability to receive care may also differ (Donohue et al., 2022). The third element is Medicaid expansion under the Affordable Care Act, whereby states can cover low-income adults who were previously excluded. However, not all the states have implemented the expansion, thus resulting in variation in the coverage.

Coverage Gaps in Medicaid
Despite being a comprehensive health insurance program, Medicaid has some gaps that limit its coverage to certain groups. First, the state determines Medicaid enrollment, and some of the low-income population is still uninsured because of restrictive income limits and non-expansion policies. This gap affects low-income adults in the states that have not adopted the expansion of Medicaid under the ACA, leaving them without the needed medical care (Albertson et al., 2020). Second, Medicaid has a lower payment rate for the healthcare providers than Medicare and other private insurance companies. Thus, many healthcare providers either restrict the number of Medicaid patients or do not accept them at all. This barrier limits the use of health care services, especially the specialty services like mental health and dental services.

The Relevance of Social Security to the American Public
Social Security is one of the most important social welfare programs in the United States, and it offers monetary benefits to retired workers, disabled persons, and dependents of deceased workers. It fosters economic security by providing pension and additional income, disability cover, and support for dependents (Cottle Hunt & Caliendo, 2022). Nevertheless, the long-term funding, the issue of an ageing population, and low worker-to-beneficiary ratios are some factors that threaten the program’s sustainability. Instead of abolishing Social Security, what should be done is to find ways to make it sustainable. Raising the payroll tax cap to ensure that high earners contribute more could also be used to solve the funding issues. Furthermore, gradually increasing the full retirement age to meet the longevity factor may help to preserve the program without cutting the benefits (Cottle Hunt & Caliendo, 2022). It is therefore important to strike a balance in order to retain Social Security while at the same time making it financially sustainable.
 
References
Albertson, E. M., Scannell, C., Ashtari, N., & Barnert, E. (2020). Eliminating gaps in Medicaid coverage during reentry after incarceration. American Journal of Public Health, 110(3), 317-321. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2019.305400Links to an external site.

Cottle Hunt, E., & Caliendo, F. N. (2022). Social security and risk sharing: A survey of four decades of economic analysis. Journal of Economic Surveys, 36(5), 1591-1609. https://onlinelibrary.wiley.com/doi/abs/10.1111/joes.12492?casa_token=r1tEuvdl_ucAAAAA:9nyihDoZMeHSxYKqQ4t0kgMxKdckLHCOsEdh47tyLMVqZKkujLV-uSHAvDHxxtYp0BjUY8Dcz9f3N7ALinks to an external site.

Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The US Medicaid program: coverage, financing, reforms, and implications for health equity. Jama, 328(11), 1085-1099. https://jamanetwork.com/journals/jama/article-abstract/2796374Links to an external site.

El-Nahal, W. (2020). An overview of Medicare for clinicians. Journal of General Internal Medicine, 35, 3702-3706. https://link.springer.com/article/10.1007/s11606-019-05327-6Links to an external site.

Simon, L., & Alpert, E. (2023). Medical-Dental Integration in Medicare: Where are We Now?. Journal of the California Dental Association, 51(1), 2249012. https://www.tandfonline.com/doi/abs/10.1080/19424396.2023.2249012%4010.1080/tfocoll.2023.0.issue-Medical-Dental_Integration