Statistics says that there are approximately 11 million American citizens who are over 65 years old and poor. These people are also known as “dual eligibles.” The term means they qualify for both Medicaid and Medicare. But there’s a catch. These two major health programs have nothing to do with each other.
So, what we have in our hands? Dual eligibles who are in a dilemma because they cannot make the most of the medical benefits and services of Medicaid and Medicare. These individuals should receive the best kind of health care.
Unfortunately, there are some issues regarding the connection of the two health programs. This is despite the fact that there is about 27% of Medicare costs and 40% for Medicaid costs account for these people.
Medicare and Medicaid Should Meet Halfway
There is a government agency that works as an umbrella for Medicare and Medicaid. It is the United States Centers for Medicare & Medicaid Services (CMS). This agency should be responsible for the alignment of the two programs. But it is not as easy as it seems, if you take into account the operations and concepts of Medicare and Medicaid. Simply put, these two are not designed to work with each other.
Dual Eligibles Suffering from Chronic Conditions
Considering the age of these people, they are more prone to have functional impairment and a few chronic illnesses. Performing daily activities proves to be difficult for them such as walking, bathing, toileting, and some other minor household chores.
In 2015, the Medicare expenditures for those with chronic diseases were seven times bigger than the amount for the ones without chronic conditions. This issue actually affects the taxpayers of America.
A report recommends integrating the services of Medicare and Medicaid into one health care program. When this happens, more than 116,000 people will benefit from it.
Ask These Important Questions
If you are a new beneficiary of Medicare, it would be helpful for you (or a family member) to ask these questions at the first stage of the medical examinations. The answer would give you some insights about Medicare Part B.
- Does the mental health system for conditions such as depression interact with the standard acute care system?
- Does it work with community or home-based healthcare providers, for example, home care, Meals on Wheels, and adult day care?
- Does the insurance company work with doctors, hospitals, and other healthcare providers?
- Does it give initial health assessment that covers the medical issues and functional needs of the individual?
While it may take some time to see the day that Medicare and Medicaid finally work together, there are ways to get the best from these two separately. Ask your insurance agent for recommendations about what approach to make. At the Dave Silver Insurance, we work hard in making sure that our clients are well-protected with policies that they can afford. To learn more about how we can help you, please contact our agency at (813) 417-2716 or Click Here to request a free quote.