There are two major programs in the field of state medical care and insurance in the United States. These programs are Medicare and Medicaid, which have an extensive network of federal organizations throughout the country. Medicare and Medicaid have three main components; the first is known as health insurance and covers inpatient hospital services and hospitalization. Among the points that determine the need for patients to stay in a hospital, there is acute intoxication, a biomedical condition and complications after severe diseases.
The second component of programs provides coverage of clients’ expenses for outpatient services. These include visits to clinics, ambulance services, and specific preventive examinations. Citizens participating in the programs generally receive most medical care services for free. Medical expenses are transferred for the services of a general practitioner, diagnostics and physiotherapy, outpatient and laboratory services, and transportation. The third component includes medical care preferred by the individual or managed by the organization’s private insurance companies. Insured persons and the self-employed population transfer contributions, which are determined according to the plan. The state makes annual payments to companies participating in these programs.
The first patient coverage gap for Medicare includes people who have reached the age of 65. The same group includes persons under 65 years of age with a disability or chronic diseases. The second patient coverage gap for Medicare is individuals who live separately and have incomes over $ 85 thousand (Berkowitz et al., 2018). The same group includes married couples with total revenue of more than $ 170 thousand per year.
The first patient coverage gap for Medicaid is for low-income elderly and disabled people and children and adults with serious illnesses. The second patient coverage gap for Medicaid includes people with low incomes. These are people who will not be able to pay for such unforeseen expenses as the treatment of a family member.
Medical services for low-income elderly and disabled people represent a large and growing share of the total costs of these medical programs. The demand for services in this area is expected to increase in the United States due to an aging population. In turn, this circumstance increases the financial burden on the state budget. For this reason, Medicaid and Medicare are not entirely appropriate in terms of cost-effectiveness. In this regard, a significant reduction in spending on these social programs is required.
Reference
Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky, T., Tishler, L. W., & DeWalt, D. A. (2018). Costly health care in dually eligible Medicare and Medicaid beneficiaries. Health Affairs, 37(4), 216-226.