Analysis of Financial Models and Effects on Health Care Providers

Financial Models of Reimbursement
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History of Medicare and Medicaid
Medicare is healthcare insurance that dates back to 1945 when President Harry S Truman created a national insurance policy to cover the elderly who could not meet their healthcare costs. The policy was then placed under the Laws of the United States in 1965 by President Lyndon Johnson (Piatak, 2017). According to healthcare statistics, over 61 million Americans benefitted from the initiative. It is estimated that the insurance will spend 18 percent of the total federal spending from 15 percent spent in 2018. To be eligible for Medicare plans, an individual should be at least 65 years old, but there are special cases who qualify before this age. There are four packages of Medicare, Part A, B, C, and Plan D. Plan A provides medical cover for inpatient while plan B provides outpatient coverage. Plan C provides alternative medical of both inpatient and outpatient (Piatak, 2017). In part C, individuals benefit from private healthcare through subscribing their monthly premiums for both plans A and B. Plan D caters for prescriptions. The plans are subsidized to reduce clinical and drug prescription costs for those who meet the requirements. For 2021 Medicare enrollment, an individual can shift from the original Medicare to Medicare Advantage provided they have been in the Medicare plans service region.
President Lyndon Johnson initiated Medicaid on July 30, 1965. He signed the insurance law to establish both Medicare and Medicaid (Piatak, 2017). Its creation aimed to facilitate access to quality healthcare to low-income families, pregnant women, disabled, and people with prolonged health conditions that required intensive care. Over the years, more people became made eligible for the program through changes made by the congress (Matulis & Lloyd, 2018). For instance, the insurance plan expanded its services to cover individuals with end-stage renal disease, dialysis and kidney transplants at severe stages. Currently, the services offered have been tailored to meet the needs of each American. The two healthcare policies have been in place to protect American citizens' wellbeing and health, save lives, and improve the State's economy and security.
Both Medicaid and Medicare were initiated to provide medical coverage to Americans wailing in abject poverty, the elderly, pregnant women, children, disabled and refugees (Matulis & Lloyd, 2018). The elderly should have attained 65 years of age to be considered eligible (Amoroso, 2019). The difference between Medicare and Medicaid is that Medicaid provides comprehensive coverage for both inpatient and outpatient. Notably, Medicare does not provide a comprehensive medical cover. Despite starting as a basic insurance company for the elderly and the poor, it has currently transformed to include access to affordable healthcare for Americans.
In my State, Maryland State, Medicaid expanded significantly in the past seven years. The total enrollment from 2017 has increased by 53 percent, and much growth is expected by 2025. The enrollment as of December 2017 was about 1.3 million people, and an increment of 35,000 recorded so far. The mas...