507 Case Mod 4: Medicare and Medicaid

507 Case Mod 4 Student’s Name Institution 507 Case Mod 4: Medicare and Medicaid Medicare and Medicaid are government-sponsored programs that provide health coverage for eligible U.S. citizens. Medicare is primarily funded by the federal government and covers individuals aged over 65 and those below the age but have disabilities (Altman & Frist, 2015). On the other hand, Medicaid is jointly funded by the federal and state governments and provides coverage to lower-income populations (Altman & Frist, 2015). It is, however, important to note that there are individuals that qualify for both programs. Regulatory and industry changes have over the years affected the operations of the two programs. Such changes have brought about significant challenges that influence the effectiveness of the programs. This paper examines the key challenges facing the two programs and offers recommendations for improvement. Medicaid A key issue facing Medicaid is access to physicians by patients enrolled in the program. According to Sommers and Kronick (2016), physicians are less likely to accept new Medicaid patients compared to those with private insurance. Therefore, while low-income earners may have Medicaid coverage, to some extent it limits their access to physicians. One of the key factors that affect the acceptance of new Medicaid patients by physicians is payment levels (Sommers & Kronick, 2016). The low acceptance rates associated with the program limits the ability of enrollees to access to care. With ACA coming into force, a rise in Medicaid enrolment was expected. However, the unwillingness by physicians to accept new Medicaid patients emerges as a key challenge that must be addressed by the federal and state governments. Another key problem facing Medicaid is the expansion of income eligibility by state governments. When ACA came into force, it sought to expand Medicaid to cover lower income-populations. However, in 2012, a Supreme Court ruling on ACA made it voluntary for states to participate in Medicaid expansion (Price & Eibner, 2013). As a result, a number of states decided not to implement the expansion, meaning that a significant number of low- and medium-income earners remain uninsured. Therefore, the unwillingness by some states to expand eligibility is a key issue facing the program. Medicare Affordability is one of the main challenges facing Medicare beneficiaries. According to Neuman and Rother (2015), the population under Medicare has significantly grown and now includes over 46 million people aged 65 and older as well as 9 million adults with a disability. The program covers a basic package, and beneficiaries have to incur significant out-of-pocket expenses as a result of premiums and services not covered such as long-term care, eye-glasses, and dent...