Medicare, Medicaid, and the Law

Oct 11, 2017 by

The American healthcare system is a very complicated thing. Our country uses an employer-based health insurance system, in which our health insurance is traditionally provided through our jobs. But, of course, not everybody can get health insurance through their employer: there are part-time workers, freelancers, and retirees to worry about. So private companies also offer health insurance directly to consumers, and the government has stepped in with programs aimed at the poor and the elderly. The government also regulates the health insurance industry, dictating what must be covered and, as of this writing, mandating that each individual in the country carry insurance. This messy web of public and private solutions mixes company profit motives with government rules and programs, creating a very complicated situation – particularly for those who get government-sponsored health coverage. Let’s take a closer look at the government’s programs.


One of the most obvious problems with an employer-based healthcare system is that it doesn’t offer a clear solution for retirees. Health insurance companies in the U.S. do offer individual plans, but absent government intervention, older folks would be at risk: many of us haven’t saved enough money to cover our health needs until we die, and a health crisis in America’s large elderly community would put a huge strain on all kinds of government programs and private resources. No wonder, then, that the government has long sponsored a healthcare program called Medicare.

Medicare is a universal healthcare program for people over 65. It’s a single-payer system paid for by taxes and provided by private companies that the government subcontracts the work to. It’s been around since 1966.

Medicare provides coverage for a lot of things, but individuals are still responsible for expenses like deductibles and copays, and there are some gaps in coverage, such as health coverage abroad. Not everyone wants to pay high copays or vacation at their own risk, of course, which is why some choose to invest in supplemental plans from the private market called Medigap plans. A Medigap plan is a plan that complements the coverage a person already receives from Medicare.


Not everyone gets healthcare through their employer, because some of us work on a freelance basis or work part-time hours that aren’t enough to make our healthcare needs a legal obligation for our employer. Some people in situations like these can buy individual health insurance plans, sometimes with a reduced price subsidized by the government. But for those with very low income, just about any health insurance premium would be too high, which is why the U.S. government came up with Medicaid.

Medicaid is another government-sponsored healthcare program, but it’s run jointly by the government and the states. While every state has participated in the program (which is not mandatory) since 1982, each state also has its own rules about eligibility. So a person using Medicaid in Syracuse, New York won’t be dealing with the same rules and regulations as a person living in another city in a different state. That’s why there are attorneys who specialize in medicaid law, helping clients – such as our hypothetical Syracuse denizen – find the specific help they need with paperwork and budgeting.

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