NURS 510 Week 4 Discussion

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.

Solution

In the U.S, the two programs provide medical and other healthcare services to specific people in the population. Medicaid is a social protection program; thus, it protects particular groups in the population against specific healthcare issues. On the other hand, Medicare is an insurance program for specific people in the community (Austin & Wetle, 2018). Medicaid is controlled by the state or federal government to offer medical services to individuals with low-income levels. The main components of Medicaid include family planning care, prescription drug costs, pediatric services, mental health care, inpatient or outpatient care, and dental health care. In contrast, Medicare offers healthcare services to older people in the U.S, especially individuals of 65 years of age and above (Mason et al., 2020). The main components of Medicare are the hospital, medical, and pharmaceutical services for elderly adults in the country.

The Affordable Care Act (ACA) proposed the expansion of Medicaid to ensure that everybody with an income below the Federal Poverty Line (FPL) is covered. However, some states have refused to expand their Medicaid eligibility under the ACA; therefore, these individuals are ineligible for Medicaid (Albertson et al., 2020). In these states, a coverage gap exists where, irrespective of the low income, the individuals are ineligible to obtain services, such as prescription drug costs, pediatric services, inpatient or outpatient care, and dental health care. In addition, Medicare also sets a coverage gap on the pharmaceutical services an elderly adult can obtain. For instance, the program sets a cap on the total amount of drugs a patient can take in a year, such that beyond this, the patient will have to pay out-of-pocket. For brand-name and generic prescription drugs, elderly adults are expected to pay no more than 25 percent of the total cost.

Health care is a human right; social security programs should be modified to offer efficient care without the different coverage gaps. Moreover, all the states should expand their Medicaid to entail ACA to derive all the benefits.

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://doi.org/10.2105/AJPH.2019.305400Links to an external site.

Austin, A., & Wetle, V. (2018). The United States Health Care System: Combining Business, Health, and Delivery (3rd ed.). Pearson Education, Inc.

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2020). Policy & Politics in Nursing and Health Care (7th ed.). Elsevier.

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