Course
Medicare Fundamentals
The program every other course is measured against: who Medicare covers and how it is financed, the administered price systems that pay hospitals and physicians, what beneficiaries actually owe, the quality programs bolted onto fee-for-service, and where traditional Medicare is heading.
By the end of this course, you will be able to:
- Describe who Medicare covers, what each of the four parts pays for, and how each part is financed
- Explain how a prospective payment system converts a base rate, case mix, and geography into a payment
- Calculate what a beneficiary owes under traditional Medicare and identify where the coverage gaps fall
- Compare the fee-for-service quality programs by their incentive structure and their measured results
- Identify whether a given Medicare policy question belongs to Congress, CMS, or MedPAC
How Medicare Is Built
Medicare covers 68 million people through four parts and two trust funds financed in very different ways. The structure everything else depends on.
How Traditional Medicare Pays
Administered prices for hospitals, physicians, and everyone else. One blueprint underlies a dozen payment systems, and learning it once is enough.
What Beneficiaries Pay
Deductibles, coinsurance with no ceiling, and the supplemental coverage market that exists because of it, plus the Part D benefit after the Inflation Reduction Act.
Quality and Value in Traditional Medicare
MIPS for clinicians and three payment adjustment programs for hospitals, plus an honest account of what more than a decade of fee-for-service pay-for-performance produced.
Medicare's Trajectory
The financing arithmetic driving reform, the three bodies that set Medicare policy, and what is actually happening to traditional Medicare as Medicare Advantage grows.