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NURS 510 Week 4 Medicare and Medicaid Programs Components Discussion


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.


Medicare is the US health insurance program for ages 65 or older. People who are younger than 65 may also qualify for Medicare if they have certain disabilities and those who have permanent kidney failure (Social Security, n.d.). Medicare has multiple parts. Medicare Part A which helps pay for hospitalization or at a “limited time in a Skilled Nursing Facility” (SNF) after hospitalization (Social Security, n.d.). Part A also pays for some home health care and hospice care (Social Security, n.d.). Medicare part B pays for “services from doctors and other healthcare providers, outpatient care, home health care, DME and some preventive services” (Social Security, n.d.).  “Medicare Advantage Plan previously known as Part C includes benefits and services covered under Part A and B- prescription drugs and additional benefits such as vision, hearing and dental bundled together as one plan” (Social Security, n.d.). Medicare Part D covers prescription drugs (Social Security, n.d.).There are gaps in Medicare Part D, there is a $445 deductible in 2021 before Medicare pays for its share (Medicare, n.d.). For many people this is a high price to pay and can’t always afford to pay the deductible. Also, for Medicare Part D there’s a temporary limit of $4130 on covered drugs after this, the person enters a coverage gap (Medicare, n.d.).  This gap affects medication compliance for many people (Baik et al., 2012). The coverage gap disproportionately impacts seniors with chronic conditions such as depression and heart failure as they are likely to fall on these gaps and reduce medication use which is counterproductive in their treatment (Baik et al., 2012).Medicaid is a public insurance program jointly funded by state and federal government however administered by individual states under federal guidelines (Mason et al., 2016). Medicaid covers hospitalization, physician care, lab services, radiology studies, prenatal care, and preventive services (Mason et al., 2016). Medicaid also covers for nursing home and home health care and medically necessary transportation (Mason et al., 2016). To qualify for Medicaid, a person must have low income, pregnant, be responsible for a child 21 years or younger, blind, have a disability or a family in your household with a disability or be 65 years of age or older (, n.d.)In 2019, despite expansion of Medicaid coverage, in 2019 there’s still about 3 million Californians who were uninsured (Person et al., 2021). Latinos uninsured rates are high; more than double in comparison to other ethnic groups (Person et al., 2021). Undocumented immigrants are also a large uninsured group since they are excluded from federally funded coverage (Person et al., 2021). Also, low- and moderate-income Californians including working-age adults continue to have high uninsured rates despite being the focus of ACA expansion coverage (Person et al., 2021).Social Security is part of the retirement plan for almost every American worker (SSA ,n.d.). It provides replacement income for those who qualify (SSA, n.d.). Social security pays benefits for those who have “already retired, those who are disabled, survivors of workers who have died and dependent of beneficiaries” (SSA ,n.d.). Personally, I strongly believe that social security benefits should remain in place but make some changes for sustainability in the future and I believe Congress should decide to fund the program to continue after 2034. According to the Treasury department, social security benefits would be paid as scheduled until 2034 (Tomwfranck, 2021). For many elderly people, this is their sole retirement income source (CBPP,n.d.). According to Arno et al., (2011) studies have shown that since implementation of Social Security benefits, there’s been a decline in mortality among the elderly population. Social security benefits have alleviated poverty and provided a safety net for many Americans especially the elderly (Arno et al., 2011). “Analysts have observed that socioeconomic disparities in health and mortality are large in infancy and early childhood, diminish through very early adulthood, widen dramatically through middle and early old age and then diminish in old age” and the only plausible explanation is the that people 65 years and older have a “substantial social welfare safety net through social security and Medicare” (Arno et al., 2011). Removing Social security would be a mistake and would cause more harm than good.


Medicare is health insurance funded by the Federal government for elderly over ages 65 years old, for younger individuals with disabilities, people with End Stage Renal Disease and Amyotrophic Lateral Sclerosis. If you have worked and paid medicare taxes when you were younger, you become eligible for this health insurance once you reach 65 years old or if you have certain conditions mentioned above.Medicaid however is funded by the Federal and the state. It is a joint program that helps pay medical cost for limited income individuals or families. To be eligible to Medicaid you have to be 65 years old or over, children up to 19 years old, pregnant, living with a disability, or a parent caring for a child with a limited income. Medicaid funding differs from state to state.Medicare has 4 major components. Part A, B, C and D.Part A helps cover inpatient hospitals, skilled nursing facilities, hospice care, and home health care.Part B helps cover outpatient care, medical services from doctors and other health care providers. It also covers home health care and durable medical equipments such as wheelchairs, walkers etc. It also covers many preventative services such as screenings, vaccines and wellness checkups. Part B usually requires a payment for the premium amount.Part C is an all in one alternative to the original medicare. It is a combination insurance from private companies. This bundle includes Part A, B, C and D. This plan may have lower out of pocket cost that the original medicare. This can also cover vision, hearing and dental services.Part D helps cover prescription drugs.As for Medicaid, you may be eligible to get most health care benefits for as long as you qualify as a low income individual or family.


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