Overview
In this module, you learned about the healthcare insurance coverage options the government offers. While programs such as Medicare and Medicaid are detailed and comprehensive, they can also be overwhelming to understand. In this assignment, you will write a brief summary that explains the factors one needs to consider for Medicare coverage. You will also create a Medicare plan grid that will simplify the requirements of Medicare for a consumer.
From strategic planning and healthcare reimbursement perspectives, this activity will help you understand the types of services Medicare and Medicaid pay for in each program. This activity will help you complete Section 2 (Strategic Planning) and Section 3 (Healthcare Reimbursement) of the course project.
Scenario
You work in a consumer-facing role in a healthcare organization where you help with finances and reimbursement. In your role, you must manage a lot of healthcare consumers who have been scammed or who have signed up for Medicare and Medicaid plans without understanding all the factors; these consumers are subsequently disappointed when their needs are not met. You have heard from many consumers who visited www.medicare.gov to understand their choices but found so much information and unfamiliar terminology that they became frustrated and quit. They often just end up signing for the “simple plan” rather than choosing something else that “might not be quite right.”
As part of an ongoing consumer-outreach program your organization has launched, you want to create some aids that will better educate your consumers about the factors that impact healthcare-reimbursement plans so they can choose a plan that is right for them. Your aids will be put up on your organization’s website for maximum impact. In your aid, explain in brief the factors that affect the consumers’ choice of Medicare and prepare a Medicare Plan Choices grid. Then determine if they will be eligible for Medicaid assistance. Here is a sample grid that will help you organize your thoughts.
| Medicare Part A | Medicare Part B | Medicare Advantage | Medicare Part D |
| Coverage includes hospital inpatient, long-term care, skilled nursing facilities, home health, hospice | Coverage includes physician services, medical services, medical supplies (i.e., outpatient coverage) | Coverage in managed care options include services excluded in Part A and Part B: long-term nursing, custodial care, dental services, vision services, hearing aids | Coverage includes Medicare drug benefit; outpatient coverage |
| No premium needed | Premium needed | Premium needed, amount depends on scope of service | Premium needed; premium amount varies |
| Deductible amount: $1,250 | Deductible amount: $142 | Deductible amount: costs vary | Deductible amount: $275 |
| Co-payment amount varies by service | Co-payment amount varies by service | Co-payment amount varies | Co-payment amount at 25% |
This activity will help you distinguish between the Medicare and Medicaid programs. It will also enable you to evaluate how Medicare and Medicaid impact consumer choice.
Directions
Create a Medicare Plan Choices guide to help consumers understand how to choose a Medicare plan. This activity includes three parts:
- At-a-Glance: Write an “at-a-glance” section to briefly explain the factors that impact the choice of a Medicare plan. Also explain if any enrollment deadlines need to be considered.
- Medicare Plan Choices Grid and Medicaid Eligibility: Create a Medicare Plan Choices grid to help consumers select the plan that is best for them. The sample grid given in the Scenario section will give you some guidance on how to create your own grid for this assignment.
- Further Support: Provide additional resources to help consumers make their choice about which type of Medicare plan is best for them, whether to consider a Medicare Advantages plan, and whether they are eligible for Medicaid.
If you need writing support, access the Online Writing Center through the Academic Support module of your course.
Specifically, you must address the following rubric criteria:
Part 1: At-a-Glance
- Summary of Relevant Factors and Deadlines: Summarize all the factors and enrollment deadlines that consumers should consider before they opt for a Medicare plan. Write your summary in one to two short paragraphs.
Consider the following questions to guide your response:
- What are the costs and coverage considerations involved in the selection of a plan?
- How do prescription drugs and choice of doctors and hospitals affect the choice of a Medicare plan?
- If a consumer misses the deadline for enrollment, can they still buy a plan?
Part 2: Medicare Plan Choices Grid and Medicaid Eligibility
- Medicare Grid: Create a grid that displays all the appropriate factors and information influencing the choice of a Medicare plan. Refer to the sample grid given in the Scenario section to help you organize your thoughts. Include the following information in your response:
- Create a brief consumer profile in one to two sentences. This profile will act as an example to help you build the grid. Consider that the consumer is in the 65+ age group. Assume some additional relevant information about their income (which will impact premiums) and eligibility (which will impact Medicaid eligibility). This information will be displayed as part of the aid on your organization’s website.
- Create the grid using the profile you built. Your grid should include the following details about each of the four parts of Medicare:
- Coverage
- Premium
- Deductible(s)
- Co-payment(s)
- Examples of covered services
- Any other details you think are important
Make sure the grid is easy for consumers to understand. Remember that they have probably already visited some websites and have found them difficult to comprehend.
Consider the following questions to guide your response:- What are the relevant details that you should include for the consumers?
- Are there any factors that will not be applicable for the consumers?
- Have you considered any supplemental coverage in the grid?
- Which terms, if any, should you define for consumers?
- Medicare Advantage and Medicaid: Determine whether a consumer should consider a Medicare Advantage plan. Also, state whether they will be eligible for Medicaid assistance and why or why not.
Consider the following questions to guide your response:- What are the benefits of a Medicare Advantage plan?
- What factors make one eligible for Medicaid?
- Can a consumer be covered by both Medicare and Medicaid at the same time?
Part 3: Further Support
- Additional Resources: Identify at least two websites or other resources to help the consumers select a Medicare plan. Add these resources as a separate section after the grid.
Consider the following questions to guide your response:
- Are the websites and resources relevant to the topic?
- Are the websites and resources credible?
- Are the websites and resources easy to understand?
All the claims in your deliverable should be evidence based. Your citations should be from your independent search for evidence (not from the scenario, textbook, or module resources) of credible sources and be current within the last five years. You are required to cite a minimum of two sources, at least one of which should be separate from your own research. Refer to the IHP 630 Library Guide located in the Start Here section of the course for additional support.
What to Submit
Submit your Medicare Plan Choices guide as a 2- to 3-page Microsoft Word document with double spacing, 12-point Times New Roman font, and one-inch margins. Make sure to include all three parts of the activity in the guide. Sources should be cited according to APA style.
Module Three Activity Rubric
| Criteria | Exemplary (100%) | Proficient (90%) | Needs Improvement (70%) | Not Evident (0%) | Value |
| Summary of Relevant Factors and Deadlines | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Summarizes all the factors and enrollment deadlines that a consumer should consider before they opt for a Medicare plan | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 20 |
| Medicare Grid | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Creates a grid that displays all the appropriate factors and information influencing the choice of a Medicare plan | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 25 |
| Medicare Advantage and Medicaid | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Determines whether a consumer should consider a Medicare Advantage plan and if they are eligible for Medicaid assistance as well, and why or why not | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 15 |
| Additional Resources | Exceeds proficiency in an exceptionally clear and insightful manner, using industry-specific language | Identifies at least two websites or other resources to help consumers select a Medicare plan | Shows progress toward proficiency, but with errors or omissions | Does not attempt criterion | 15 |
| Articulation of Response | Exceeds proficiency in an exceptionally clear and insightful manner | Clearly conveys meaning with correct grammar, sentence structure, and spelling, demonstrating an understanding of audience and purpose | Shows progress toward proficiency, but with errors in grammar, sentence structure, and spelling, negatively impacting readability | Submission has critical errors in grammar, sentence structure, and spelling, preventing understanding of ideas | 10 |
| Scholarly and Professional Sources | Incorporates more than two scholarly, professional, current (within the last five years) sources, or use of sources is exceptionally insightful | Incorporates two scholarly, professional, current (within the last five years) sources that support claims | Incorporates fewer than two scholarly, professional, current (within the last five years) sources, or not all sources support claims | Does not incorporate sources | 10 |
| APA Style | Formats in-text citations and reference list according to APA style with no errors | Formats in-text citations and reference list according to APA style with fewer than five errors | Formats in-text citations and reference list according to APA style with five or more errors | Does not format in-text citations and reference list according to APA style | 5 |
| Total: | 100% | ||||
