Conner 1 Conesia Conner Professor Rand English 1102- 021 March 29, 2014 The Real Difference between

Medicaid/Medicare and Private Insurance In todays society many people are experiencing an increased amount of medical care and need from doctors, clinics and emergency departments and despite their conditions, some Americans may not be able to get the care they need. Currently, this year the Obama Care Plan has come into effect, causing those without health insurance to either find insurance coverage or be penalized by the state for not doing so by the end of March of 2014. This brings about my inquiry question of, What is the difference between Medicare/Medicaid and private insurance and how does it affects Americans today? Most times many people that are on the lower end of economical wealth are left without care because they cannot afford it, which is a disparity in our health care system today. Those who are qualified are offered the option to sign up for Medicare or Medicaid. Medicaid can be defined as a medical service program for certain individuals and families with low incomes and few resources (Crosta). Medicare can then be defined as a federal health insurance program that pays for hospital and medical care for elderly and the disabled Americans, at or over the age of 65 (Crosta). Parts A through D cover a beneficiary depending upon their condition and medical attention that person needs. Collectively, I will be analyzing the differences between those who are covered by Medicare/Medicaid versus those with private insurance plans and how these types of plans are being adjusted by the recent health care reform. In the past, Medicaid and Medicare was created by the Social Security Amendment of 1965. President Lyndon Baines Johnson was in office during this time and he is who signed

Conner 2 Medicare into law (Medicare Turns 48). Although Harry S. Truman was known as the real daddy of Medicare, he brought rise to the first Medicare card. It was initially a program that helped states provide medical coverage for low-income families and others who met the requirements such as the blind, aged, disabled, and pregnant women and those over the age of 65. Medicaid helped families of dependent children, or infants with low incomes or those who could not afford private insurance plans. In earlier times, these two health insurance plans only covered families with low incomes, and it wasnt until 1972 that those over the age of 65 with long term disabilities was eligible for Medicare (Medicare Turns 48). When the cost of living was low in the late 1900s, beneficiaries paid $40 for an annual deductible for part A of Medicare. The monthly premium for part B of Medicare was about $3 (Medicare Turns 48). Now you can say thats the good life. Imagine if those currently being assisted with these programs only had to pay $3 dollars a month. Everyone would have insurance coverage then, no worries right? In addition to the research I conducted, in 1997 part C of the Medicare plan was recessed by George W. Bush and he expanded Medicare across America. Part C included private insurance plans giving citizens HMO style Medicare. Lastly, in 2006 Part D of the Medicare plan was then put into effect which allowed enrolled beneficiaries to receive subsidized prescription drug coverage (Medicare Turns 48). Private insurance or any insurance in that case was once never heard of in earlier times. How did normal Americans pay for health care before the 1900s? Did they even go to the doctor during these times? Thats a sight to see everyone treating themselves and coming up with homemade remedies to cure diseases because they couldnt afford to go the hospitals and doctor offices in their neighborhoods. Well this all changed when private insurance plans were introduced 1910s as a pre-paid group practice. Beneficiaries would pay a monthly premium and

Conner 3 received a wide range of medical services through an exclusive group of providers (Lichtenstein). Slowly over time BlueCross BlueShield became a licensed private insurance provider and in 1929 Blue Cross Plans were established to provide pre-paid hospital care, based on a prototype developed at Baylor University in Dallas, Texas by Justin Ford Kimball. Around 1955 the spread of health insurance coverage went from less than 10 percent of the population having coverage in 1940, caused a growth of 70 percent. BlueCross and BlueShield then became recognized by their logo in both homes and medical offices all across America (Lichtenstein). Currently in 2014, all of these rules and regulations have been altered due to the new Health Care reform bill passed by Obama. Medicaid and Medicare may seem like very beneficial programs but despite the eligibility requirements, it can only serve those who are under the income requirements set by the state. This program is offered by the state, in who determines the rate of payments, the types of services that will be covered and eligibility standards. On the downside, those who may be covered in one state might not be eligible in another due to different rules and regulations (McMenamin). Medicaid requirements according to the North Carolina Department of Health and Human Services are as follows: Be a U.S. citizen or provide proof of eligible immigration status, individuals only applying for emergency services are not required to provide documentation of immigration status, live in North Carolina, and provide proof of residency and have a Social Security number or have applied for one. Medicare also covers those who are blind, over the age of 65, or disabled. If you have a family size of one, the income limit is $958.00 and for two the income is $1,293.00. For those with infants and children for instance a family of 5 cannot make more the $4,595. For families with dependent children ages 19-20 cannot bring in no more than $594 a month. Lastly pregnant women cannot bring in more than $3,554 a month (Who is Eligible . . .). So as you can see these incomes are very low

Conner 4 and may seem unrealistic for some families to live off of these low budgets. What about those citizens who make lets say over $2,000 a year and want to apply for Medicaid or Medicare. They are over the requirement of a family size of one and for a family of two as well. This income wouldnt be stable enough for anyone to afford a home, a car, or let alone food. So what do you do with these people who cannot afford private insurance plans and who are not eligible for government assisted programs such as these? Its not fair to leave these people out and with the health care reform being placed into action, people as I described will be penalized just because they cannot afford health insurance. Diving back into the aspects of Medicaid and Medicare, heres where another issue comes about, the question of What types of health procedures does Medicaid/Medicare cover? Based upon the actual Medicare website, this program covers lab test, surgeries, doctor visits and supplies such as walkers and wheelchairs and the widely used plans parts A,B and D specialize in certain conditions and needs of beneficiaries (Medicare). Part A of this insurance plan covers its beneficiaries on hospital care, nursing home care, Hospice, and home health services for the elderly or disabled (Medicare). Part B covers medically necessary services such as preventative services, clinical research, and also mental health. Part D of insurance like I stated before deals drug coverage and the staggering cost of prescription drugs wrote out by a doctor. Medicaid, somewhat a different insurance plan covers many of the similar health procedures as Medicare does. With their prime focus on low income families and their children, they cover general aspects of doctor and hospital bills, prescription drugs, vision, and dental insurance (What Is Medicaid?). Private insurance plans on the other hand covers a broader range of medical procedures and a beneficiaries can actual pick plans that pertain to them and their medical needs and how much money that person is willing to spend. Based upon BlueCross

Conner 5 BlueShield certain plans cover annual exams, blood tests, colposcopies, mammograms and deal with a lot of preventative care procedures (Individual and Family Plans). So these insurance plans cover people who are poor and have a low income, and those who can afford private health care insurance plans. The cost of which should be analyzed to realize the drastic difference of price that Medicaid/Medicare and private insurance portray. Based on Medicare.gov, Medicare part B premium cost no more the $104.90 each month and the deductible is around $147 per year. Part A of Medicare does not charge beneficiaries a monthly premium but if you do buy part A, it will cost $426.00 each month (Medicare 2014 Costs at a Glance). These prices are as well interchangeable with that of Medicaid for 2014 as well the deductibles for part D up to $310 before coverage kicks in. Part A increases as well due to hospital stays which is a deductible $1,126 (Barry). This price is very high considering the since of those who are poor and barely bring in income to securely support their families. In other words, private insurance plans drastically increase from these prices of government assistance. Families that can afford to pay these higher deductibles may see insurance cost fit for their types of lifestyles. BlueCross BlueShield has multiple plans available for their beneficiaries. The most common plans such as in network benefits charge no more than $45 for copays. Deductibles vary for those who are covering their families which range from about $0-12,700. Individuals pay no more than $6,350 for their deductibles. Out of network benefit individuals pay a deductible of no more than $250-12,700 (Lichtenstein). So with all this information one may ask what is the difference between these two types of insurance plans? In a study carried out by the University Of Colorado: School Of Medicine, they compared the association between barrier to timely primary care and emergency department (ED) utilization among adults with Medicaid versus private insurance (Cheung). To do so,

Conner 6 researchers analyzed 230,258 adults from the years of 1999 to 2009 of a National Health Interview Survey. Of these adults 24,986 used Medicaid/Medicare insurance and 205,272 of the population had private insurance. They evaluated 5 specific barriers dealing with timely primary care which included unable to get through on the telephone, unable to obtain an appointment soon enough, long waits in the physicians office, limited clinic hours, and lack of transportation. They also looked at ED utilization of Medicare and private insurance beneficiaries (Cheung). The results of this study concluded that Medicaid beneficiaries were more than twice as likely to have more than one ED visit then private insurance owners. Also pertaining to the 5 barriers listed above, these complications existed most prevalent in Medicaid and Medicare users. The most significant data resulted in a comparison of the issue of no transportation which affected 7.6% of Medicare users versus private insurance owners at only 0.6% (Cheung). Also, Medicare patients had to wait too long in the office which pertained to 7.6% of users and only 3.6% of private insurance users (Cheung). Collectively Medicare beneficiaries were twice as likely to have greater than one barrier at a percentile of 16.3 compared to that of private insurance beneficiaries at only 8.9% (Cheung). So what does this all mean? Insurance has been around since the 1960s and is still thriving today due to the Health care Reform proposed by the Obama administration, our current president. Medicare and Medicaid are great benefits for those who qualify and meet the income requirements but if you make too much money then you can see these options out the window. Private insurance, as you read is at sky rocketing prices, and those who are finically stable are seen to afford the best of the best coverage. I feel as those we overlook the middle class which is the majority of America. Some people may make more than the Medicare and Medicaid income cut off but are still struggling to provide for their families and private insurance is not in

Conner 7 the budget for them. Also people with Medicare and Medicare receive a lower quality of health care which is not fair just because of their low income. Every citizen of America should be provided the same health care coverage, freedom and offered the same opportunities in life despite race, income and location. Applying the Obama Care plan is not a healthy solution to equaling out the insurance disparities of America. Not everyone in North America can afford health care plans whether it be Medicare/Medicaid or private insurance plans. This will also cause a division in the quality of the two options and this is not causing a resolution for any of the Americans today in 2014. As well as adding penalties for those not being able to find a plan is absolutely absurd. If someone cannot afford to pay for medical insurance what makes the government think that they will be able to provide their state money for the penalties they will receive. I think that a reasonable solution to this insurance issue is that the government should offer every American citizen the same medical procedures to be covered on Medicaid, Medicare, and private insurance. The prices of the insurance plans should be adjusted accordingly to fit every familys income. It should not include just include an income limit or a cut off rather yet adjust the cost of insurance based on family size and their specific income. This may not solve every issue in our health care systems today, but if it were to come into effect, it would in my eyes put insurance coverage for the rich and the poor will be insured the same quality.

Conner 8 Works Cited Barry, Patricia. "What Does Medicare Cost?" AARP. N.p., n.d. Web. 30 Mar. 2014. Cheung, Paul T. , MPH, Wiler, Jennifer L. , MD, MBA, Lowe, Robert A., MD, MPH, Adit A. Ginde, MD, MPH. National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries. Annals of Emergency Medicine. Volume 60, Issue 1, Pages 410.e2. July 2012. Web. 19 Mar. 2014.

Crosta, Peter. "What Is Medicare / Medicaid?" Medical News Today. MediLexicon International, n.d. Web. 29 Mar. 2014. "Individual and Family Plans." Health Insurance for North Carolina. BlueCross BlueShield of North Carolina, n.d. Web. 30 Mar. 2014. Lichtenstein, Marc. "Blue Cross and Blue Shield Blog." Health Insurance from Invention to Innovation: A History of the Blue Cross and Blue Shield Companies. BlueCross BlueShield Association, n.d. Web. 30 Mar. 2014. "Medicare 2014 Costs at a Glance." Medicare.gov: The Official U.S. Government Site for Medicare. N.p., n.d. Web. 28 Mar. 2014. "Medicare.gov. The Official U.S. Government Site for Medicare. Medicare, n.d. Web. 30 Mar. 2014. "Medicare Turns 48." AARP.org. Ed. Melissa Stanton. AARP, July 2013. Web. 28 Mar. 2014. McMenamin, Sara B., MPH, PhD, Halpin, Helen A., ScM, PhD, Ganiats, Theodore G. , MD. Medicaid Coverage of Tobacco-Dependence Treatment for Pregnant Women: Impact of the Affordable Care Act. American Journal of Preventive Medicine. Volume 43, Issue 4, Pages e27e29. October 2012. Web. 19 March, 2014.

Conner 9 PBS NewsHour. Arguments Brew at State Level over Medicaid Expansion. Online video clip. YouTube. YouTube, 5 July, 2012. Web. 19 Mar. 2014. "What Is Medicaid?" NC DMA: Medicaid Home. N.p., n.d. Web. 28 Mar. 2014. "Who Is Eligible - Infants, Children, & Families." NC DMA: Medicaid for Infants, Children, and Families. N.p., n.d. Web. 29 Mar. 2014.

Conner 10 Reflection 1. What was the most interesting thing you learned in this inquiry process? 2. What did you struggle with during the research and/or writing process? How did you overcome this obstacle? 3. Did your inquiry question change over time? If so, how did it change, and why do you think it changed? 4. Why is it important to look at a historical view of your topic/question? 5. Do you think your analytical/evaluation skills have changed as a result of the inquiry project? If so, how? 6. What are you most proud of in this process? 7. What more would you like to know about this subject?