Medicare and Medicaid Federal Health Insurance Programs

Social workers should assure that patients have access to health care through private or public health insurance. The majority of Americans obtain their health insurance through their employers (Darnell & Allen, 2019). However, populations of low socioeconomic status and senior citizens could use publicly funded health insurance if they are eligible. The main difference between public and private health insurance is funding. Private health insurance plans include out-of-pocket payments or employer payments of monthly premiums to insurers with extra fees in some cases when public programs are funded through tax revenues (Darnell & Allen, 2019).

The access to health care services provided by private health insurances could vary due to geography, companies, and occupations. Access to services covered by public health insurance depends on programs accepted in states. Each state that adopted the Affordable Health Care Act (ACA) customizes “essential health benefits” in its benchmark plans (Collins, 2012). These benefits include pediatric, preventive and wellness services, rehabilitative and habiliative services, chronic disease management, hospitalization, maternity and newborn care, prescription drugs, laboratory services, and mental health and substance use disorder services.

Medicare and Medicaid are federal health insurance programs designed for vulnerable populations. Medicare is strictly a federal program, eligible to citizens and legal residents who permanently lived in the USA for five years and more (Medicare Consumer Guide, n. d.). They must be 65 and older, but the younger population could also qualify for the program if they have Lou Gehrig’s disease or end-stage renal disease. In New Jersey, people could consider Original Medicare (A and B Parts), Medicare Advantage, and Medigap plans, as well as stand-alone Medicare Part D Prescription and Medicare Advantage Prescription Drug plans (Medicare Consumer Guide, n. d.).

Part A is basic and covers inpatient hospitals, hospices, several home healthcare services, and nursing facilities. Other parts are voluntary and need extra payments. (Darnell & Allen, 2019). Thus, cost, benefits, services provided, and limitations in services of Medicare vary due to chosen plans.

Medicaid is administered on the state level and covers individuals and their families with an income below 133% of the national poverty line. In New Jersey, Medicaid provides insurance for citizens and qualified aliens who meet specific standards for income and belong to the categories of pregnant women, families with dependent children, and permanently disabled or blind people who are 65 or older (State of New Jersey, n. d.).

Medicaid supports services of physicians, nurses, and midwives, outpatient and inpatient hospital services, prenatal care, family planning, vaccines, screening, diagnosis, and treatment for children, etc. Compared to Medicare, Medicaid also provides coverage for long‐term care in nursing homes (Darnell & Allen, 2019). Services are limited to certain income requirements, but people with special circumstances could enroll in Medicaid Special and Medically Needy programs.

New Jersey also offers special programs for vulnerable populations. They are the Medical Emergency Payment Program for Aliens, Home and Community Based Services Programs for seniors and people with disabilities, and New Jersey Cancer Education and Early Detection Program (State of New Jersey, n. d.). These programs expand the standard limitations of Medicaid. Individuals complying with the requirements for Medicaid except for their status of immigrants could obtain coverage of medical emergency services. People with income below 250% of the Federal Poverty Level are eligible for early cancer detection. A variety of programs for the elderly and disabled offers many opportunities for caregivers and people receiving their health care services at home.


Collins, S. (2012). Essential health benefits and Affordable Health Care Act: What social workers need to know. Practice Perspectives. Web.

Darnell, J. S. & Allen, H. L. (2019). Health policy and social work. In Gehlert, S., & Browne, T. (Eds.), Handbook of health social work (3rd., pp. 120-138). Wiley. Web.

Medicare Consumer Guide. (n. d.). Medicare coverage in New Jersey. Web.

State of New Jersey. (n. d.). NJ Medicaid. State of New Jersey: Department of Human Services, Division of Medical Assistance & Health Services. Web.

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