The purpose of this course is to provide students with an introduction to Medicare and Medicaid. Areas covered include costs and financing of the programs, eligibility, program administration, and benefits. Relationships between state and federal agencies will be explored. Proposals and prospects for fundamental program reform will be covered as well. Students will learn about the States Children Health Insurance Program.
Upon successful completion of this course, the student will be able to:
- Discuss the background of the Social Security Act and the coverages of entitlement programs.
- Describe the process of applying for Medicare and Medicaid.
- List Medicare and Medicaid eligibility rules and enrollment requirements.
- List Medicare and Medicaid covered services, deductibles, and co-payments.
- Describe the coverage criteria for each of the Medicare programs.
- Discuss problem areas and challenges for those who advocate for Medicaid recipients and Medicare beneficiaries.
- Describe Medicare’s relationship with private insurance and with providers of services and products.
- Discuss coordinated care plans, capitation, private fee-for-service, pay for performance, and other delivery of service options.
- Discuss issues for Medicare beneficiaries who are also eligible for Medicaid.
- Have a basic understanding of the components of a Medicaid pharmacy program, including: rebates, drug utilization review, prior authorization and preferred drug lists.
- Have a basic understanding of the State’s Children Health Insurance Program.
- Discuss the impact that federal health care reform is having on Medicaid and Medicare.
PHA 6280 Syllabus