Medicare Basics: An Overview for States Seeking to Integrate Care for Medicare-Medicaid Enrollees

ICRC Technical Assistance Brief
Publisher: Washington, DC: Integrated Care Resource Center
Jun 13, 2017
Authors
Jenna Libersky, James Verdier, and Ryan Stringer

States seeking to better integrate care for Medicare-Medicaid enrollees (dual eligibles) need to understand Medicare benefits, provider and health plan payment, and beneficiary cost-sharing provisions in order to better structure and coordinate the Medicaid benefits they will be offering to these beneficiaries. This technical assistance brief provides an overview of these Medicare issues and, where relevant, highlights important areas of overlap with Medicaid, including coverage of nursing facility services, home health, durable medical equipment, hospice, transportation, and prescription drugs. It also provides a brief summary of how rates are set for Medicare providers and in Medicare Advantage managed care programs.