• Katherine Shi

Breaking it Down: Medicaid, Medicare, and the ACA



You may be familiar with the terms Medicaid and Medicare, and perhaps even heard your family members arguing about the Affordable Care Act. The complexity of the healthcare industry may be daunting, so in this article we will be exploring and breaking down three major issues.

Medicaid and Medicare: What’s the Difference?


Medicare

Medicare is a federal health insurance program funded partly by Social Security and Medicare taxes. It serves people 65 years and older primarily, but also younger disabled people and dialysis patients. If you are eligible, you can choose to get Medicare benefits from Original Medicare, which is a traditional, fee-for-service health plan, or a Medicare Advantage Plan, which is offered by private companies approved by Medicare. There are two parts to Original Medicare: Part A (aka Hospital Insurance, which covers inpatient hospital stays, care in a skilled nursing facility, etc.) and Part B (aka Medical Insurance, which covers outpatient care, preventative services, etc.). Medicare Advantage Plans must also provide Part A and B services, though with different rules, costs, and restrictions. However, they also offer Part D coverage, or prescription drug coverage, which helps cover the cost of prescription drugs.


Medicaid (See if you qualify for your state’s Medicaid program by going to: https://www.healthcare.gov/medicaid-chip/.)

Medicaid is a joint federal and state assistance program that provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. It is the main source of long term care coverage for 1 in 5 Americans, especially because the majority of enrollees lack access to other affordable health insurance. Medicaid covers a broad range of health health services and patients usually pay no part of the costs for covered medical expenses, though a small co-payment (which is a fixed amount for a covered service, paid before receiving service) may sometimes be required. In some states the program covers all low-income adults below a certain income level. Medicaid eligibility varies, depending on what state you live in, which has subsequently resulted in coverage gaps in adults. This is where the Affordable Care Act comes in.

The Controversy of the Affordable Care Act


In 2010, President Barack Obama passed a comprehensive healthcare reform law known as the Affordable Care Act (aka Obamacare) in order to standardize Medicaid requirements. It was created specifically to expand Medicaid to nonelderly adults with incomes below 138% of the federal poverty line, allowing adults without dependent children to be covered and was meant to also protect consumers from insurance company tactics that might drive up patient costs or restrict care. Millions of Americans have benefitted by receiving insurance coverage through the ACA, many of which are unemployed or have low-paying jobs. Some couldn’t work because of a disability or family obligations. Others couldn’t get decent health insurance because of a pre-existing medical condition, such as a chronic disease. Despite these positives, the Act remains controversial.


Conservatives see it as an inappropriate government intrusion into the healthcare industry, saying the law imposed too many costs on business. They object to the tax increases and higher insurance premiums needed to pay for Obamacare. Some people in the healthcare industry are critical of the additional workload and costs placed on medical providers, and think it may have negative effects on the quality of care. As a result, there are frequent calls for the ACA to be repealed or overhauled. Republicans launched a legal challenge, which ended in June 2012 when the US Supreme Court declared the law constitutional but made Medicaid expansion optional for states.

There’s no doubt that healthcare is a significant, often controversial issue, but it’s also complex. In order to make more informed decisions about your health coverage, it’s important to gain a better understanding of these terms, the issues that surround them, and to see whether you qualify. Keep educating yourself so that you know exactly what is happening with your healthcare coverage.


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