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IHP 630 Module Three Activity Guidelines and Rubric

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 �nances 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.

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 bene�t;

outpatient coverage

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Medicare Part A Medicare Part B Medicare Advantage Medicare Part D

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 brie�y 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.

Speci�cally, 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?

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Part 2: Medicare Plan Choices Grid and Medicaid Eligibility

1. Medicare Grid: Create a grid that displays all the appropriate factors and information in�uencing 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 pro�le in one to two sentences. This pro�le 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 pro�le 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 dif�cult 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 de�ne 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 bene�ts 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 time?

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:

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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 �ve 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.

Module Three Activity Rubric

Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

Summary of Relevant

Factors and Deadlines

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Summarizes all the factors and

enrollment deadlines that a

consumer should consider

before they opt for a Medicare

plan

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 20

Medicare Grid Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Creates a grid that displays all

the appropriate factors and

information in�uencing the

choice of a Medicare plan

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 25

Medicare Advantage and

Medicaid

Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Determines whether a

consumer should consider a

Medicare Advantage plan and if

they are eligible for Medicaid

assistance as well, and why or

why not

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Additional Resources Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Identi�es at least two websites

or other resources to help

consumers select a Medicare

plan

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

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Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

Articulation of Response Exceeds pro�ciency 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

pro�ciency, 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 �ve years)

sources, or use of sources is

exceptionally insightful

Incorporates two scholarly,

professional, current (within

the last �ve years) sources that

support claims

Incorporates fewer than two

scholarly, professional, current

(within the last �ve 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 �ve

errors

Formats in-text citations and

reference list according to APA

style with �ve or more errors

Does not format in-text

citations and reference list

according to APA style

5

Total: 100%