According to Spath (2018), FOCUS PDCA is a frequently used quality improvement model used to improve processes.
May 12, 2022
Topic: Cerebral
May 12, 2022

510 replies week 4

2 replies, APA and References

Due date: 08/01/2020 10 AM ET


Week 4 Discussion Prompt


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Identify three major components of the Medicare and Medicaid programs and, based on these components, identify at least two patient coverage gaps for each of the programs. Be clear when you describe the coverage and the gaps as they may relate to specific ages, patient populations, or disease entities. Use primary sources to identify the components and the gaps. Additionally, discuss your stand (criticize or defend) regarding the relevance of the Social Security program to the American public. Should the program be left alone, modified, drastically changed, or eliminated? Provide the rationale and use facts to defend your position.

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Reply 1 Kristopher

The components of Medicare and Medicaid Programs include three parts, the first which are Part A that covers hospital benefits or inpatients. The second component is Part B, which focuses on covering outpatient medical benefits and Part C, covering alternative options of receiving supplementary benefits. Medicare is a program that focuses on providing healthcare coverage for individuals above the age of 65 or individuals under this age brackets but with disabilities besides any income status. On the other hand, Medicaid programs focus on providing healthcare coverage to individuals from low-income families. However, both of these federal programs in promoting the healthcare sector in the United States have coverage gaps. The gaps make it difficult for everyone stated to access healthcare services using these coverage programs (Kane, 2019).

For the Medicare federal healthcare coverage program, some of the coverage gaps include lacking the cost that covers the support service for medical issues such as hearing, dental care, and eye problems. In this case, individuals with this coverage program cannot get their expenses for such services catered for hence creating difficulties for them to seek such services. Another coverage gap for Medicare programs is that people with it have to acquire additional covers to meet some of their healthcare needs, which is costly for them like catering for custodial care.

Similarly, the Medicaid federal program has coverage programs like lacking coverage for individuals who cannot live alone unless they have conditions such as disabilities. In this case, few people benefit from this program because of the limiting factors and requirements. Also, this coverage program does not cover healthcare issues and conditions, which may be critical to individual health. The people have to purchase other healthcare coverage premiums for catering to some expensive medical cost, which creates a gap within this program (Blumberg et al., 2018).

The Social Security Program is a critical element to the American public, considering that it provides protection for individuals with disabilities and protects workers and deceased workers’ survivors, among other vulnerable populations. The program is a critical and essential process for many Americans. I think there is a need for modifications to make it better and level across all the regions in the United States. Each state in the country provides its guidelines which create healthcare coverage inequalities in entire America. Therefore, there is a need to have uniform guidelines across the country to ensure that there is equality within the country (Börsch-Supan et al., 2016).




Reply 2 Ivana


Medicare is a health insurance program that provides benefits to the seniors who are 65 or older and those with disabilities and/or certain illnesses such as end stage renal disease, etc. It is a fee for service health-plan, that includes Part A- hospital insurance and Part B Medical insurance. Part A covers inpatient care, skilled nursing facility, hospice and home health care. If you are under Part A coverage, you do not pay a monthly premium. Part B covers outpatient care, screenings, vaccines, and medical equipment/supplies.  People with Part B coverage pay for a premium amount. Another component is pharmaceutical, Medicare provides affordable medication and your health consumer status determines how much you pay and how much is covered by Medicare (Centers for Medicare and Medicaid Services; 2020).

Medicaid is another type of health insurance program that assist to pay medical costs to the population with low-income and resources. To be eligible for Medicaid, you must have limited income, a child under 19 years of age, pregnant, and/or a child living with a disability. When applying for Medicaid, we must remember that each state is different and may have different policies about eligibility. This type of insurance program covers for hospital stays, doctor visits, vision and dental visits, maternity visits, prescription drug costs, PT/OT, etc. (Centers for Medicare and Medicaid Services; 2020).

A patient coverage gap in Medicare health program is that it does not pay for some services such as dental and vision services, hearing aids and nursing homes. Another coverage gap is that Medicare Part A and B do not cover most prescription medications (Damico; 2019). A patient coverage gap in Medicaid program is that people in the coverage gap have limited family income and they are ineligible for many financial assistances with their health coverage.

I think that Social Security program should be left alone, the program helps the workers who have a disability or experience the death of a spouse and those who have retired. Millions of people receive monthly social security benefits, the money is collected through tax, employers and employees each pay a certain percent of wages. “Social Security replaces a percentage of a worker’s pre-retirement income based on your lifetime earnings. The amount of your average wages that Social Security retirement benefits replaces varies depending on your earnings and when you choose to start benefits” (Social Security Administration; 2020).

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