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.
Sample Grid for Medicare Plan Choices Guide
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
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 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
1. 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:
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 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.
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. Deductible(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 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?
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 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 !me?
Part 3: Further Support
1. 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.
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 insighful
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
Determines
whether a
consumer should
consider a
Medicare
Shows progress
toward proficiency,
but with errors or
omissions
Does not attempt
criterion
15
Module Three Activity Rubric
language Advantage plan and
if they are eligible
for Medicaid
assistance as well,
and why or why not
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 intext citations and
reference list
according to APA
style
5
Total: 100%
