Medicare and Medicaid Managed Care Plans

In 1965, the American government created Medicare and Medicaid health programs, which were meant to pay for the cost incurred in health care provision. These programs are sponsored by the government and funded through taxes. Medicare is a social health insurance funded by the government, and it covers medical expenses for individuals above sixty five years of age. This program also covers medical expenses of individuals who are under sixty five years, but suffers from disabilities, or advanced kidney diseases (Hall, Harman &, Zhang, 2008).

Medicaid is a health insurance program that is jointly funded by the federal government and individual states. This insurance program was designed to cover health expenses of people with low income. Individuals that benefit from this program include children and pregnant women from poor backgrounds, and institutionalized people (Hall, Harman &, Zhang, 2008). This paper is going to examine the similarities and differences of Medicare and Medicaid health insurance plans, and the possible solutions to the challenges facing these programs.

Similarities and Differences of Medicare and Medicaid Health Insurance Plans

In terms of strength, both Medicare and Medicaid settle medical bills for sick people who cannot afford to pay for certain medical services. These two medical insurance programs receive their funding from the federal government making them reliable. However, Medicaid receives some of its funding from the state government. Another common strength between these two medical programs is that they both provide medical cover to individuals living with disabilities, regardless of their age (Grabowski, 2007). One of the major weaknesses of both Medicare and Medicaid is that both programs have stringent criteria for provision of medical services. For example, for one to benefit from Medicare he or she must be sixty five years. Beneficiaries under sixty five years must be either disabled, or suffering from advanced kidney disease (Grabowski, 2007).

Medicaid on the other hand, only provides medical cover to individuals with low income. Other factors such as age, disability, and pregnancy status are also considered. Medicare and Medicaid may therefore leave out people who are in need of medical assistance because of failing to meet these stringent measures. However, Medicaid provides cover for a wider range of medical services compared to Medicare. The main incentives offered by Medicare are broad coverage, fewer limitations, unproblematic administration, and low co-pay. Medicaid, just like Medicare, also has a broad coverage. However, Medicaid as opposed to medicare provides its clients with a broad health package, and the freedom of choosing a health provider. In addition, beneficiaries of Medicaid are insulated from paying for a variety of medical services out of their pockets (Grabowski, 2007).

Access to Medicare has been expanding over the years with a large number of senior citizens joining the program. Medicare has also ensured greater access to its users by enabling them to receive medical services from the main stream medical system. Medicaid has ensured access to its clients through universality and the creation of new eligibility categories (Grabowski, 2007). The risk to consumers associated with Medicare is that sometimes medical professionals misuse this insurance. Some doctors normally prescribe very expensive medical examinations to patients covered by Medicare. These doctors order such examinations with the knowledge that the patient is only suffering from minor medical problems. This abuse is based on the fact that Medicare pays for any type of examination recommended by a medical doctor. Doctors engage in this practice as away of soothing patients, and generating additional revenue (Grabowski, 2007).

Medicare and Medicaid health insurance programs play a significant role in the American health system. This is because these two programs cover individuals who do not qualify for any other health insurance program, that is, the old and those with low income. To improve the health services offered through Medicare, the following need to be done. First, prescription medicines which are affordable to the general public need to be developed. This will help in reducing cost incurred in providing drugs to the beneficiaries of this program as stipulated in the drug coverage section. Second, Medicare should also incorporate free screening for common cancers. This will help in reducing the cost incurred in treating these cancers in old age. Finally, the number of physicians who provide primary care should also be increased to enable better access to medical services (Bradley, Gardiner, Given &, Roberts, 2005).

More funds need to be availed for Medicaid programs because currently, many states still face the problem of adequately reimbursing health care providers on Medicaid. Medicaid should also be made a main medical insurance in the US as opposed to the current perception that it covers poor people. This will ensure that all Americans have a health insurance, and can access medical services in the conventional healthcare system. The provision that beneficiaries of Medicaid should regularly prove that they are eligible should also be removed to ensure wider access (Bradley, Gardiner, Given &, Roberts, 2005).


Medicare and Medicaid are important medical insurance because they cushion people who cannot benefit from private insurance. Currently, these programs face certain challenges, but solutions can be found to ensure that these programs meet the medical needs of Americans.


Bradley, C. J., Gardiner, J., Given C. W. &, Roberts, C. (2005). Cancer, Medicaid enrollment, and survival disparities. Cancer, 103(8): 8-17.

Grabowski, D.C. (2007). Medicare and Medicaid: Conflicting incentives for long-term care. National Center for Biotechnology Information, 85(4):579-610.

Hall, A. G., Harman, J. S. &, Zhang, J. (2008). Lapses in Medicaid coverage: Impact on cost and utilization among individuals with diabetes enrolled in Medicaid. Med Care, 46(12):25-121.

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