Medicare choice plan

Overview

In this module, you learned about the healthcare insurance coverage op!ons 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 perspec!ves, this ac!vity will help you understand the types of

services Medicare and Medicaid pay for in each program. This ac!vity will help you complete Sec!on 2 (Strategic Planning)

and Sec!on 3 (Healthcare Reimbursement) of the course project.

Scenario

You work in a consumer-facing role in a healthcare organiza!on 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 informa!on and unfamiliar terminology that they became frustrated and quit. They o#en 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 organiza!on has launched, you want to create some aids that will

be$er 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 organiza!on'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.

Sample Grid for Medicare Plan Choices Guide

Medicare Part A Medicare Part B Medicare Advantage Medicare Part D

Coverage includes hospital inpa!ent, long-term care, skilled nursing facili!es, home health, hospice

Coverage includes physician services, medical services, medical supplies (i.e., outpa!ent coverage)

Coverage in managed care op!ons 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; outpa!ent coverage

No premium needed Premium needed Premium needed, amount depends on scope of service

Premium needed; premium amount varies

Deduc!ble amount: $1,250 Deduc!ble amount: $142 Deduc!ble amount: costs vary

Deduc!ble amount: $275

Co-payment amount varies by service

Co-payment amount varies by service

Co-payment amount varies Co-payment amount at 25%

This ac!vity will help you dis!nguish between the Medicare and Medicaid programs. It will also enable you to evaluate how

Medicare and Medicaid impact consumer choice.

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Direc!ons

Create a Medicare Plan Choices guide to help consumers understand how to choose a Medicare plan. This ac!vity includes

three parts:

At-a-Glance: Write an “at-a-glance” sec!on 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 sec!on will give you some guidance on how to

create your own grid for this assignment.

Further Support: Provide addi!onal 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 wri!ng support, access the Online Wri!ng Center through the Academic Support module of your course.

Specifically, you must address the following rubric criteria:

Part 1: At-a-Glance

1. 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 ques!ons to guide your response:

What are the costs and coverage considera!ons involved in the selec!on of a plan?

How do prescrip!on drugs and choice of doctors and hospitals affect the choice of a Medicare plan?

If a consumer misses the deadline for enrollment, can they s!ll buy a plan?

Part 2: Medicare Plan Choices Grid and Medicaid Eligibility

1. Medicare Grid: Create a grid that displays all the appropriate factors and informa!on influencing the choice of a

Medicare plan. Refer to the sample grid given in the Scenario sec!on to help you organize your thoughts. Include the

following informa!on in your response:

A. 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 addi!onal relevant informa!on

about their income (which will impact premiums) and eligibility (which will impact Medicaid eligibility). This

informa!on will be displayed as part of the aid on your organiza!on’s website.

B. Create the grid using the profile you built. Your grid should include the following details about each of the four

parts of Medicare:

i. Coverage

ii. Premium

iii. Deduc!ble(s)

iv. Co-payment(s)

v. Examples of covered services

vi. 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 ques!ons 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?

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2. 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 ques!ons 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 !me?

Part 3: Further Support

1. Addi!onal Resources: Iden!fy at least two websites or other resources to help the consumers select a Medicare plan.

Add these resources as a separate sec!on a#er the grid.

Consider the following ques!ons 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 cita!ons 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 sec!on of the course for addi!onal support.

What to Submit

Submit your Medicare Plan Choices guide as a 2- to 3-page Microso# Word document with double spacing, 12-point Times

New Roman font, and one-inch margins. Make sure to include all three parts of the ac!vity in the guide. Sources should be

cited according to APA style.

Criteria Exemplary (100%) Proficient (90%) Needs

Improvement (70%) Not Evident (0%) Value

Summary of Relevant Factors

and Deadlines

Exceeds proficiency in an excep!onally clear and insigh&ul 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 a$empt criterion

20

Medicare Grid Exceeds proficiency in an excep!onally clear and insigh&ul manner, using industry-specific language

Creates a grid that displays all the appropriate factors and informa!on influencing the choice of a Medicare plan

Shows progress toward proficiency, but with errors or omissions

Does not a$empt criterion

25

Medicare Advantage and

Medicaid

Exceeds proficiency in an excep!onally clear and insigh&ul manner, using industry-specific

Determines whether a consumer should consider a Medicare

Shows progress toward proficiency, but with errors or omissions

Does not a$empt criterion

15

Module Three Ac!vity Rubric

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language Advantage plan and if they are eligible for Medicaid assistance as well, and why or why not

Addi!onal Resources

Exceeds proficiency in an excep!onally clear and insigh&ul manner, using industry-specific language

Iden!fies 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 a$empt criterion

15

Ar!cula!on of Response

Exceeds proficiency in an excep!onally clear and insigh&ul manner

Clearly conveys meaning with correct grammar, sentence structure, and spelling, demonstra!ng an understanding of audience and purpose

Shows progress toward proficiency, but with errors in grammar, sentence structure, and spelling, nega!vely impac!ng readability

Submission has cri!cal errors in grammar, sentence structure, and spelling, preven!ng 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 excep!onally insigh&ul

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 cita!ons and reference list according to APA style with no errors

Formats in-text cita!ons and reference list according to APA style with fewer than five errors

Formats in-text cita!ons and reference list according to APA style with five or more errors

Does not format in- text cita!ons and reference list according to APA style

5

Total: 100%

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