These laws regulate the programs that provide health care benefits to eligible individuals, including low-income families, seniors, and people with disabilities.
Medicare eligibility: An overview of the basic criteria that must be met in order to qualify for Medicare benefits, including age, disability, and specific medical conditions.
Medicaid eligibility: Overview of who is eligible to receive Medicaid benefits, including income and asset limitations, age, disability, and medical conditions.
Medicare coverage: A review of the various "parts" of Medicare coverage, including hospital insurance (Part A), medical insurance (Part B), and prescription drug coverage (Part D), and the limitations and costs associated with each.
Medicaid coverage: Overview of the types of services and treatments that are covered under Medicaid, including medical care, hospitalizations, prescription drugs, and preventive care.
Medicare billing and claims: Explanation of how Medicare claims are processed, including coding and reimbursement rates for healthcare providers, and the role of the various intermediary entities (e.g. Medicare Administrative Contractors) in the claims process.
Medicaid billing and claims: A review of the claims processing system for Medicaid claims, including coding, reimbursement rates, and the role of state Medicaid agencies and managed care organizations.
Fraud and abuse: Discussion of the various fraud and abuse laws that apply to Medicare and Medicaid, including the False Claims Act, the Anti-Kickback Statute, and the Stark Law.
Medicare Advantage and other private insurance options: Overview of Medicare Advantage plans and other private insurance options that are available to Medicare beneficiaries.
Long-term care: An overview of the various long-term care options available, including home health care, nursing homes, and assisted living facilities, and the role of Medicare and Medicaid in covering these services.
Health care reform: Discussion of the Affordable Care Act and other recent reforms affecting Medicare and Medicaid, including changes to eligibility, coverage, and reimbursement rates.
Medicare Part A: Provides inpatient hospitalization coverage, skilled nursing facilities, hospice care, and some home healthcare services.
Medicare Part B: Provides medical insurance for doctor visits, outpatient services, medical equipment, and preventive services.
Medicare Part C: Known as Medicare Advantage, provides an alternative way to receive Medicare coverage through private insurance companies.
Medicare Part D: Provides prescription drug coverage.
Medicaid Expansion: This is a provision of the Affordable Care Act, which expanded Medicaid coverage to adults with incomes up to 138% of the federal poverty level.
Medicaid Waivers: States may apply to the federal government to waive certain Medicaid provisions to expand coverage or test new approaches in delivering Medicaid services.
Home and Community-Based Services (HCBS): This program provides home and community-based services to individuals who would otherwise be institutionalized in a nursing home or other similar facility.
Managed Care: This involves using private insurance plans to deliver Medicaid services, with the goal of improving care coordination and cost efficiency.
Long-Term Services and Supports: Medicaid covers long-term care services for eligible individuals, including nursing home care, home healthcare services, and personal care assistance.