Question

Who is eligible for Medicaid?

Who is eligible for Medicare?

How is Medicaid financed?

How is Medicare financed?

What factors affect the demand for private insurance?

Answer 1

Who is eligible for Medicaid?

In the US, Medicaid is the single largest source of health coverage. IT is a joint program of federal and state government along with the Children’s Health Insurance Program. It extends its health coverage to over 72.5 million Americans. Especially children, pregnant women, parents, seniors and individuals with disabilities are covered.

In order to be covered under Medicaid, the federal law mandates the states to cover certain groups of individuals like low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. The States have additional provisions for coverage of other groups, such as individuals receiving home and community-based services and children in foster care who are not otherwise eligible. The Affordable Care Act of 2010 provides the chance for states to expand Medicaid to include nearly all low-income Americans under age 65. Eligibility to include children was extended to at least 133 percent of the federal poverty level (FPL) in every state.T he states were given the chance to extend eligibility to adults with income at or below 133 percent of the FPL. Most of the states have expanded the coverage to adults and others may do so at any time.

The mandatory eligibility groups

Low-Income Families

Transitional Medical Assistance

Extended Medicaid due to Child or Spousal Support Collections

Children with Title IV-E Adoption Assistance, Foster Care or Guardianship Care

Qualified Pregnant Women and Children

Mandatory Poverty Level Related Pregnant Women

Mandatory Poverty Level Related Infants

Mandatory Poverty Level Related Children Aged 1-5

Mandatory Poverty Level Related Children Aged 6-18

Deemed Newborns

Individuals Receiving SSI

Aged, Blind and Disabled Individuals in 209(b) States

Individuals Receiving Mandatory State Supplements

Individuals Who Are Essential Spouses

Institutionalized Individuals Continuously Eligible Since 1973

Blind or Disabled Individuals Eligible in 1973

Individuals Who Lost Eligibility for SSI/SSP Due to an Increase in OASDI Benefits in 1972

Who is eligible for Medicare?

Medicare is a health insurance policy offered to the senior-citizen set, people under 65 who are disabled in certain ways are also included in this program. It is not an income-based support. The paid Medicare taxes from the earnings one will make you automatically eligible for Medicare at age 65.

One may qualify for Medicare due to a disability if he/she have been receiving SSDI checks for more than 24 months, also known as the two-year waiting period. One will automatically be enrolled in Medicare at the beginning of the 25th month in this situation. While receiving SSDI because of Amyotrophic Lateral Sclerosis(ALS), Medicare automatically begins the first month along with the starting of SSDI benefits.

People with End-Stage Renal Disease (ESRD) or kidney failure will be eligible for Medicare even if under.

People will qualify for Medicare if diagnosed with ESRD and are undergoing dialysis treatments or have had a kidney transplant.

People who are eligible to receive Railroad Retirement benefits.

The individual, a spouse, or a parent have paid Medicare taxes for the required period of time as specified by the Social Security Administration.

How is Medicaid financed?

Medicaid program is jointly funded by the federal government and states. The Federal Medical Assistance Percentage (FMAP) will be provided by states as a specific percentage of program expenditures. The States make sure that they can provide their part of Medicaid expenses for the care and services available under their plan.

The Medicaid provider payment rates can be regulated by the States on their own within federal requirements. It is generally paid by fee-for-service or managed care arrangements.

How is Medicare financed?

Medicare funding primarily comes from Social Security Administration like general revenues, payroll tax revenues, and premiums paid by beneficiaries. Other sources of income for Medicare include taxes on Social Security benefits, payments from states and its interest.

All taxpayers pay 1.45% of the earnings into Federal Insurance Contributions Act and employers pay another 1.45% which makes a total of 2.9%.

What factors affect the demand for private insurance?

The increased used of private health insurance in the United States is due to the rise in medical fees, development in medical care facilities, improvement of medical technology, the invention of new drugs, widespread use of health screening practices and diffusion of health insurance. The demand for private insurance is driven by the quality gap between public and private healthcare.