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

Medicare is a federal program primarily for individuals aged 65 and older, but it can also cover younger people with disabilities. The program has four parts: Part A takes care of hospital stays. This part helps pay for things like staying in the hospital, care in a nursing home, hospice Care and home health. One gap is high out of pocket cost, need to pay a lot of money for long term services. Elderly people will have high cost due needing the long-term services. Secondly people under 65 who have disabilities may not get adequate help to manage chronic illness.

Part B covers outpatient services like doctor visits, preventive Care and follow ups. The coverage gap is about some preventive care may be cover, and some medications are not fully cover. These people might need to pay more out of pocket. Part C combines A and B through private plans, and Part D helps with prescription drug costs. A major gap is the “Donut hole” means people will need to start to pay out of pocket when they reach a certain cost threshold. Low-income elderly find it difficult to afford high premiums and deductibles.

On the other hand, Medicaid is a program designed to help low-income individuals and families, funded by both state and federal governments. It covers various services, including hospital visits, doctor appointments, and long-term care. However, many low-income adults without children do not qualify for Medicaid in certain states, leaving them without essential coverage. Additionally, while Medicaid covers many medical services, it often does not include specific therapies like physical therapy or mental health services, which are vital for individuals recovering from illness or trauma.

Both Medicare and Medicaid play crucial roles in the American healthcare system, but gaps in coverage can create obstacles for patients in need. These gaps particularly affect seniors who require dental care and low-income adults who lack comprehensive medical services. Addressing these gaps would significantly improve the health and well-being of countless individuals who depend on these programs for support.

The Social Security program is equally important for American citizens, offering financial assistance to retirees and people with disabilities. Instead of eliminating or making drastic changes to the program, it should be modified to ensure it remains effective. With an aging population, the demand for Social Security will only grow. Small adjustments, such as gradually raising the retirement age or revising benefit calculations, can help keep the program stable for future generations. Preserving Social Security is vital for the financial security of millions of Americans who rely on it for their livelihoods.

Reference:

Mason, D., Dickson, E.L., Perez, G.A., & McLemore, M. (Eds.). (2021). Policy & politics in nursing and healthcare. (8th ed.). Elsevier.

U.S. Department of Health and Human Services. (n.d.). What’s the difference between Medicare

and Medicaid? Retrieved 03/26/2025 from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html

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