C2 MEDICARE ELIGIBILITY AND FINANCING
An awareness of the covered and noncovered services of Medicare is a critical area of understanding for health care managers. The program has grown and changed over time, refining who and what is included vs. excluded. The Case presents the opportunity to investigate these coverages, as well as the financing of Medicare. Specific reimbursement rules are in place that must be followed if funds are to be received for providing services. The level of Medicare reimbursement differs from what would be received from private insurance – but by how much – and how can this affect your bottom line?
Using the information in the required readings, as well as some additional research in peer-reviewed sources, complete your Case assignment by answering the following:
1. Investigate the eligibility of the Medicare program; who can be covered?
2. How is the Medicare program financed? What specific operating rules must be followed to receive reimbursement funds?
3. How does the average Medicare reimbursement level specifically compare to the average reimbursement for private insurance? How can this difference affect the bottom line at your facility?
References
Andersen, M. (2018). Effects of Medicare coverage for the chronically ill on health insurance, utilization, and mortality: Evidence from coverage expansions. Journal of Health Economics, Vol. 60, 75-89.
Centers for Medicare & Medicaid Services. (2019). Medicare current beneficiary survey. Available at: www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index.html.
Centers for Medicare and Medicaid Services. (2019). Medicare program – General information. Available at: https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html
