Medicare services, nursing services, home services, preventative

Medicare and Medicaid have insured millions of people over the years that otherwise would not have been able to afford healthcare. Medicare is federal insurance for anyone over the age of 65 or anyone under the age of 65 with a disability or kidney disease. It covers services like inpatient hospital stays, outpatient services, hospice, home healthcare, skilled nursing, rehabilitation, prescription assistance, and most preventative care services.

If hospitals want to be reimbursed by Medicare the organization has to pass an accreditation visit by the Joint Commission or  a Medicare certification visit. Medicare will not reimburse hospitals for poor accreditation, meaning providing insufficient quality care; they will also not reimburse the organization if a patient obtains a hospital acquired infection. This has cause vast improvements in the quality of care patients are receiving. Medicaid was introduced as a federal and state program to provide health coverage for people with low income. Each state establishes its’ own eligibility requirements; providers are reimbursed from the state rather than the government (Nowicki, 2015, pg.

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98, 102, 109). Medicaid is required to cover the following services: inpatient/outpatient hospital services, nursing services, home services, preventative services, physician and clinic services, transportation to medical services, laboratory and x-ray services, family planning services, and tobacco cessation for pregnant women. Each individual state then has the option to include dental services, vision services, prescriptions, physical, speech and occupation therapies, dentures, prosthetic, respiratory services, podiatry, glasses, chiropractic care, hospice, case management, and inpatient psychiatric services for persons under 21 (, n.

d.).  HIPAA (Health Insurance Portability and Accountability Act of 1996), was designed to help increase the availability of health insurance to families. It allowed people to have access to their medical record which got people more involved in their healthcare and medical treatments. The act protected currently insured people from losing coverage because they were changing jobs or a family illness. In 2000 it mandated standardized, electronic billing and in 2006 it allowed self-employed individuals to increase their tax reduction for health insurance costs from 30% to 80%, and lastly it tightened fraud and abuse rules (pg. 115-116). HIPAA promoted increased use of electronic transactions and eliminated unnecessary papers, saving money and time.

 Overall the most significant benefits Medicare and Medicaid have accomplished is providing more affordable healthcare to people, causing more people seeking healthcare, and increasing the number of people covered by health insurance. The combination of all three programs have required organizations to invest in the quality of care they provide and ensure their patient’s safety and health are of most importance. One of the main challenges of Medicare and Medicaid is how and who should pay for the services; the government or the people. People are staying alive longer leaving more people on the Medicare services and more and more people are qualifying for Medicaid due to the increased income limits and decreased affordability of employer health insurance or unemployment.

  According to the 2017 annual report “both Social Security and Medicare face long-term financing  shortfalls”. Medicare is funded by workers but also by two trust funds, which according to the Trustees, the funds will be depleted in 2029 (Vernon, 2017). A challenge for the healthcare industry regarding HIPAA is knowing who to talk to and what information can be disclosed. Many people in the healthcare industry have adopted the “Say nothing to nobody” practice which have run some healthcare professionals into trouble. At times healthcare personnel would not even give the patient their own health information in fear of giving out information that could cause them to get in trouble or bring about a lawsuit against the organization.

Proper training and education of HIPAA terminology should take place with each and every employee. For Medicare and Medicaid, financial security to pay for these services is worrisome, however the benefits that both programs have brought to people outweigh this challenge. More people have been able to seek healthcare, people are living longer because of affordable healthcare and prescriptions, and both programs have provided people with less stress and hesitancy regarding their health. The most vulnerable populations (elderly, disabled, and pregnant women, and children) are being cared for.

Despite the challenges HIPAA has brought to the table, the benefits have outweighed them as well. The transition from paper to electronic has made vast improvements of quality and ease of care. It has cut down on paper costs and timeliness of using personnel.

HIPAA has ensured the privacy of millions of people regardless of the drawbacks from uneducated or inexperienced users. (n.d.).

List of Medicaid Benefits. Retrieved from, M. (2015). Introduction to the Financial Management of Healthcare Organizations.

Chicago, Illinois: Health Administration PressVernon, S. (2017). Money Watch on CBC News. Medicare funding: problems and solutions. Retrieved from


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