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Medicare—the federal health insurance program for adults aged 65 and older and for younger people with permanent disabilities—consists of four parts. Part A, the hospital insurance (HI) program, covers inpatient hospital, skilled nursing, and some home health care. For beneficiaries who choose to enroll and pay a monthly premium, Part B, the supplementary medical insurance (SMI) program, covers outpatient services like physician, laboratory, outpatient hospital, and medical equipment. Medicare Advantage, or Part C, lets beneficiaries choose to receive their Part A and B benefits through participating private health plans. Part D provides prescription drug coverage through private plans for beneficiaries who enroll and pay the required premium. In 2007, over 44 million people were covered by the Medicare program.

The Forum's body of work on Medicare issues focuses on the mechanics of its fee-for-service and managed care payment policies, how the payment policies affect the participation of providers and plans, the services available to its beneficiaries, and private payers and the health care market. The Forum also examines the quality assurance mechanisms Medicare has implemented, the role of Medicare in shaping the health care delivery system, and the impact of the Medicare program on the federal budget.

Search Results for Medicare

Small-Group SessionMarch 5, 2010
Medicare Fee Schedule: What’s the RUC Got to Do With It?
Manager: Laura A. Dummit

Forum SessionFebruary 26, 2010
Assessing and Ensuring Health Plan Provider Network Adequacy
Manager: Kathryn Linehan

Forum SessionJanuary 14, 2010
Health Information Exchange: Building the Infrastructure for Better Care
Managers: Rob Cunningham, Consultant & Lisa Sprague

Forum SessionNovember 13, 2009
Health Care Provider Consolidation and Reform
Manager: Laura A. Dummit

Forum SessionOctober 30, 2009
Prevention and Early Detection of Health Care Fraud, Abuse, and Waste
Manager: Mary Ellen Stahlman

The BasicsOctober 14, 2009
Discharge Planning and Medical Social Services in Fee-for-Service Medicare
Author: Kathryn Linehan

Background Paper  No. 70August 31, 2009
Coverage and Payment for Prescription Drugs Under Medicare Part B: A Complex Patchwork
Author: Amanda Cassidy, Consultant

Issue Brief  No. 833July 31, 2009
The Medicare Drug Benefit: Update on the Low-Income Subsidy
Author: Mary Ellen Stahlman

The BasicsJuly 29, 2009
Paying the Bills: Medicare Administrative Contractors
Author: Laura A. Dummit

Forum SessionMay 29, 2009
High Rehospitalization Rates: Causes, Costs, and Accountability
Manager: Laura A. Dummit

Forum SessionMay 1, 2009
Great Expectations: Managing the Centers for Medicare & Medicaid Services
Manager: Laura A. Dummit

Site VisitApril 17 & August 7, 2009
Coordinating Care for People with Multiple Chronic Conditions: The Guided Care Model and Other Innovative Approaches
Authors: Judith D. Moore & Carol V. O'Shaughnessy

Forum SessionApril 3, 2009
Promising Models of Care Coordination for Adults with Multiple Chronic Conditions: Getting Closer to the Holy Grail?
Manager: Carol V. O'Shaughnessy

Forum SessionMarch 27, 2009
Coordinating Care for Adults with Multiple Chronic Conditions: Searching for the Holy Grail
Manager: Carol V. O'Shaughnessy

The BasicsFebruary 12, 2009
Relative Value Units (RVUs)
Author: Laura A. Dummit

Fundamentals BriefingFebruary 6, 2009
Medicaid, Employers, and Medigap: Wrapping Around Medicare
Manager: Mary Ellen Stahlman

Fundamentals BriefingJanuary 30, 2009
The World of Prescription Drugs: Approvals, Pricing, and Purchasing
Managers: Laura A. Dummit & Mary Ellen Stahlman

ToolsJanuary 15, 2009
Medicare and Medicaid Briefings: Common Health Care Terms

The BasicsJanuary 15, 2009
Medicare
Author: Mary Ellen Stahlman

The BasicsJanuary 15, 2009
The Medicare Drug Benefit (Part D)
Author: Mary Ellen Stahlman

Fundamentals BriefingJanuary 15–16, 2009
Understanding Medicare and Medicaid: Fundamentals and Issues for the New Congress
Managers: Christie Provost Peters, Jennifer Ryan & Mary Ellen Stahlman

Forum SessionDecember 11, 2008
Medicare and Medicaid Demonstrations: Experimenting for the Future
Managers: Mary Ellen Stahlman & Jennifer Ryan

The BasicsNovember 28, 2008
Long-Term Care: Consumers, Services, and Financing
Author: Carol V. O'Shaughnessy

Forum SessionNovember 13, 2008
Medical Imaging Services: Utilization, Spending, and Appropriateness
Manager: Laura A. Dummit

Issue Brief  No. 827November 3, 2008
Primary Care Physician Supply, Physician Compensation, and Medicare Fees: What Is the Connection?
Author: Laura A. Dummit

Forum SessionOctober 30, 2008
Exploring Comparative Effectiveness: Fundamentals and Controversies of Cost-Effectiveness Analysis
Manager: Michele J. Orza, ScD

Forum SessionAugust 1, 2008
Medicare's Hospice Benefit: In the Spotlight
Manager: Mary Ellen Stahlman

The BasicsJuly 30, 2008
Medicare Demonstrations
Author: Amanda Cassidy, Consultant

Background Paper  No. 63July 22, 2008
The Fundamentals of Medicare Demonstrations
Author: Amanda Cassidy, Consultant

Small-Group SessionMay 2, 2008
Physician Income and Medical Practice Differences Across Specialties: Should Medicare Care?
Manager: Laura A. Dummit

Forum SessionApril 11, 2008
Employer Use of Medicare Private Fee-for-Service Plans as a Retiree Health Benefit
Manager: Mary Ellen Stahlman

Forum SessionJanuary 17, 2008
Running Up the Health Care Tab: Will We Have Buyer's Remorse?
Managers: Mary Ellen Stahlman & Christie Provost Peters

Forum SessionDecember 14, 2007
The Ethics in Patient Referrals Act: The Stark Law and the Practice of Medicine
Manager: Laura A. Dummit

Forum SessionNovember 30, 2007
Medicare Advantage Special Needs Plans Reauthorization: What Should Congress Consider?
Manager: Christie Provost Peters

Forum SessionOctober 19, 2007
Medicare Drug Utilization Management: Balancing Cost, Convenience, and Access
Manager: Mary Ellen Stahlman

Background Paper  September 24, 2007
Medicare Advantage Payment Policy
Author: Mark Merlis, Consultant

Issue Brief  No. 825September 10, 2007
Physician Profiling: Can Medicare Paint an Accurate Picture?
Author: Laura A. Dummit

Background Paper  August 21, 2007
Medicare's Use of Risk Adjustment
Author: Gerald F. Kominski, PhD, Consultant

Forum SessionJuly 13, 2007
What Can Physician Profiling Do for Medicare?
Manager: Laura A. Dummit

Forum SessionJune 22, 2007
Medicare Advantage in 2007: What Are the Choices?
Manager: Mary Ellen Stahlman

Forum SessionJune 1, 2007
Getting the Fees "Right" and Medicare Physician Spending
Manager: Laura A. Dummit

Background Paper  May 9, 2007
The Prescription Drug Safety Net: Access to Pharmaceuticals for the Uninsured
Author: Jack Hoadley, PhD, Consultant

Fundamentals BriefingFebruary 22–23, 2007
Understanding Medicare and Medicaid: Fundamentals and Issues for the New Congress
Managers: Christie Provost Peters & Mary Ellen Stahlman

The BasicsFebruary 14, 2007
Medicare's Mental Health Benefits
Author: Christopher W. Loftis, PhD

Meeting ReportDecember 6, 2006
A Report from the Forum Session "Complexity, Coordination and Compromise: States and the Medicare Drug Benefit" (August 4, 2006)
Author: Lee Partridge, Consultant

Background Paper  November 27, 2006
Medicare and Mental Health: The Fundamentals
Authors: Christopher W. Loftis, PhD & Eileen Salinsky

Forum SessionNovember 17, 2006
The Medicare PDP Market: Build It and the Plans Will Come
Manager: Mary Ellen Stahlman

Issue Brief  No. 818November 10, 2006
Updating Medicare's Physician Fees: The Sustainable Growth Rate Methodology
Author: Laura A. Dummit

Issue Brief  No. 817November 8, 2006
The Nuts and Bolts of PDPs
Author: Mary Ellen Stahlman

Forum SessionOctober 13, 2006
Medicare Physician Spending: Past as Prologue?
Manager: Laura A. Dummit

Issue Brief  No. 815October 9, 2006
Medicare Physician Payments and Spending
Author: Laura A. Dummit

Forum SessionAugust 4, 2006
Complexity, Coordination and Compromise: States and the Medicare Drug Benefit
Managers: Judith D. Moore & Jennifer Ryan

Issue Brief  No. 813August 2, 2006
A Closer Look at the Medicare Part D Low–Income Benchmark Premium: How Low Can It Go?
Author: Mary Ellen Stahlman

Forum SessionMarch 31, 2006
Medicare Provider Payments: Proposals from MedPAC and the Administration
Manager: Laura A. Dummit

Forum SessionMarch 17, 2006
Physician Spending Growth: Do We Get What We Pay For?
Manager: Laura A. Dummit

Background Paper  February 8, 2006
Health Benefits in Retirement: Set for Extinction?
Author: Mark Merlis, Consultant

Forum SessionNovember 18, 2005
Medicare Advantage Special Needs Plans: A New Opportunity for Integrated Care?
Manager: Christie Provost Peters

Issue Brief  No. 808November 11, 2005
Medicare Advantage SNPs: A New Opportunity for Integrated Care?
Author: Christie Provost Peters, Consultant

Forum SessionOctober 21, 2005
Medicare Health Support: Working with Physicians?
Manager: Lisa Sprague

Meeting ReportSeptember 22, 2005
A Report from the Forum Session “Implementing the Medicare Prescription Drug Benefit: Continuing Challenges for States”
Author: Lee Partridge, Consultant

Issue Brief  No. 804July 13, 2005
Specialty Hospitals: Can General Hospitals Compete?
Author: Laura A. Dummit

Forum SessionJuly 12, 2005
Implementing the New Medicare Drug Benefit: Continuing Challenges For States
Manager: Judith D. Moore

Forum SessionJune 10, 2005
How Will They Know? Where Will They Go? Education and Outreach for the Medicare Drug Benefit
Manager: Judith D. Moore

Forum SessionApril 28, 2005
Understanding Medicare Advantage Bidding and Payment: Effects on Plan Choice and Beneficiary Premiums
Manager: Nora Super

Site VisitMarch 29–31, 2005
Exploring California's Rural Health System: From the Redwood Forests to the Baja Border
Authors: Eileen Salinsky & Jessamy Taylor

Fundamentals BriefingJanuary 13–14, 2005
Understanding Medicare and Medicaid: Fundamentals and Issues for the New Congress
Managers: Nora Super & Jennifer Ryan

Forum SessionDecember 1, 2004
Implementing the Formulary Requirements Under the New Medicare Prescription Drug Benefit
Manager: Dawn M. Gencarelli

Forum SessionSeptember 17, 2004
From 10 to 50: Options for Medicare Advantage Plan Regions
Manager: Nora Super

Meeting ReportAugust 31, 2004
A Report from the Forum Session “Implementing the New Medicare Drug Benefit: Challenges and Opportunities for States”
Authors: Judith D. Moore & Jennifer Ryan

Forum SessionJuly 22, 2004
Implementing the New Medicare Drug Benefit: Challenges and Opportunities for States
Managers: Judith D. Moore & Jennifer Ryan

Issue Brief  No. 797May 10, 2004
Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?
Author: Nora Super

The BasicsApril 26, 2004
State Pharmacy Assistance Programs
Author: Jennifer Ryan

Forum SessionApril 13, 2004
Implementing the MMA: Insights from Two Seasoned Administrators
Manager: Judith D. Moore

Forum SessionFebruary 6, 2004
Evidence- and Value-Based Approaches to Drug Formularies: What Role Will They Play in the Medicare Prescription Drug Benefit?
Manager: Dawn M. Gencarelli

Background Paper  November 14, 2003
Bridging Silos, Part I: Linkages among the DI, SSI, Medicare, and Medicaid Programs
Author: Karen Matherlee, Consultant

Background Paper  November 14, 2003
Bridging Silos, Part II: DI, SSI, Medicare, and Medicaid Issues and Initiatives
Author: Karen Matherlee, Consultant

Forum SessionOctober 22, 2003
Dually Eligible for Medicare and Medicaid: Two for One or Double Jeopardy?
Managers: Nora Super & Jennifer Ryan

Issue Brief  No. 794September 30, 2003
Dually Eligible for Medicare and Medicaid: Two for One or Double Jeopardy?
Authors: Jennifer Ryan & Nora Super

Forum SessionSeptember 25, 2003
The Medicare Prescription Drug Proposals and Health Insurance Risk
Manager: Dawn M. Gencarelli

Background Paper  September 15, 2003
Shaping Public Programs through Medicare, Medicaid, and SCHIP Waivers: The Fundamentals
Author: Cynthia Shirk, Consultant

Issue Brief  No. 793September 4, 2003
The Medicare Prescription Drug Proposals and Health Insurance Risk
Author: Dawn M. Gencarelli

Forum SessionJuly 30, 2003
The Geography of Medicare: Explaining Differences in Payment and Costs
Manager: Nora Super

Forum SessionJuly 9, 2003
Preferred Provider Organizations: Bringing the Mainstream to Medicare?
Manager: Lisa Sprague

Issue Brief  No. 792July 3, 2003
The Geography of Medicare: Explaining Differences in Payment and Costs
Author: Nora Super

Forum SessionMarch 26, 2003
Medicare and Chronic Conditions: Breaking Down Barriers to Better Care
Manager: Nora Super

Fundamentals BriefingJanuary 23–24, 2003
Understanding Medicare and Medicaid: Fundamentals and Issues for the New Congress
Managers: Nora Super & Jennifer Ryan

Forum SessionNovember 25, 2002
A Medicare Prescription Drug Benefit: Exploring Issues Raised in a CBO Report
Manager: Robin J. Strongin, Consultant

Site VisitNovember 12–14, 2002
The Medicare and Medicaid Intersection: Caring for Arizona's Seniors
Authors: Nora Super, Lisa Sprague & Judith Moore

Forum SessionOctober 2, 2002
Medigap: Prevalence, Premiums, and Opportunities for Reform
Manager: Nora Super

Issue Brief  No. 782September 9, 2002
Medigap: Prevalence, Premiums, and Opportunities for Reform
Author: Nora Super

Forum SessionJuly 18, 2002
Managing Advanced Illness: A Quality and Cost Challenge to Medicare, Medicaid, and Private Insurers
Manager: Karen Matherlee, Consultant

Forum SessionJuly 12, 2002
Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?
Manager: Dawn M. Gencarelli

Small-Group SessionJuly 10, 2002
Modernizing Medicare: The Homebound Rule and Next Steps
Manager: Judith D. Moore

Issue Brief  No. 779June 20, 2002
Managing Advanced Illness: A Quality and Cost Challenge to Medicare, Medicaid, and Private Insurers
Author: Karen Matherlee, Consultant

Issue Brief  No. 775June 7, 2002
Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?
Author: Dawn M. Gencarelli

Forum SessionApril 26, 2002
Pharmacy Benefits: New Concepts in Plan Design
Managers: Veronica V. Goff, Consultant & Sally Coberly, PhD

Issue Brief  No. 772March 8, 2002
Pharmacy Benefits: New Concepts in Plan Design
Author: Veronica V. Goff, Consultant

Site VisitMarch 4–5, 2002
Transitions along the Continuum of Care: Elderly and Disabled Persons in New York
Authors: Lisa Sprague & Nora Super

Background Paper  January 25, 2002
From Diagnosis to Payment: The Dynamics of Coding Systems for Hospital, Physician, and Other Health Services
Author: Karen Matherlee, Consultant

Site VisitJanuary 8–11, 2002
Managed Care: As Good As It Gets? (Los Angeles)
Authors: Lisa Sprague & Sally Coberly, PhD

Forum SessionNovember 28, 2001
Reconsidering Medicare+Choice: What Options Remain?
Manager: Nora Super

Forum SessionNovember 2, 2001
Medicare Coverage: Lessons from the Past, Questions for the Future
Manager: Robin J. Strongin, Consultant

Background Paper  August 2001
Medicare Coverage: Lessons from the Past, Questions for the Future
Author: Robin J. Strongin, Consultant

Issue Brief  No. 765July 9, 2001
Pharmacy Benefit Managers: A Model for Medicare?
Author: Veronica V. Goff, Consultant

Forum SessionJuly 9, 2001
Pharmacy Benefit Managers: A Model for Medicare?
Manager: Veronica V. Goff, Consultant

Issue Brief  No. 764June 22, 2001
Federal and State Perspectives on GME Reform
Author: Karen Matherlee

Forum SessionJune 22, 2001
Federal and State Perspectives on GME Reform
Manager: Karen Matherlee

Site VisitMay 5, 2001
Health Care Financing Administration Central Office
Author: Nora Super

Issue Brief  No. 762April 25, 2001
State-Based Pharmaceutical Assistance Programs: Temporary Fix or Lessons for Medicare?
Author: Robin J. Strongin, Consultant

Forum SessionApril 25, 2001
State-Based Pharmaceutical Assistance Programs: Temporary Fix or Lessons for Medicare?
Manager: Robin J. Strongin, Consultant

Forum SessionFebruary 23, 2001
Reflections on HCFA: Former Administrators Speak Their Minds
Manager: Nora Super

Issue Brief  No. 758September 8, 2000
Medicare+Choice: Where to from Here?
Author: Nora Super

Forum SessionSeptember 8, 2000
Medicare+Choice: Where to from Here?
Manager: Nora Super

Issue Brief  No. 756June 16, 2000
HCFA's Outpatient PPS: Finally Ready to Roll?
Author: Karen Matherlee

Forum SessionJune 16, 2000
HCFA's Outpatient PPS: Finally Ready to Roll?
Manager: Karen Matherlee

WorkshopApril 27–28, 2000
Hospital-Based Health Care Systems: The Post-BBA Era
Managers: Nora Super, Lisa Sprague & Karen Matherlee

Site VisitApril 10–11, 2000
Site Visit to Seattle — University of Washington Academic Medical Center
Author: Karen Matherlee

Forum SessionMarch 31, 2000
Designing a Medicare Prescription Drug Benefit: Safety and Structure Considerations
Manager: Robin J. Strongin

Site VisitMarch 20, 2000
Site Visit to Detroit — Henry Ford Health System
Author: Lisa Sprague

Site VisitMarch 16–17, 2000
Site Visit to Richmond and Hampton Roads — Bon Secours Health System, Inc.
Author: Nora Super

Issue Brief  No. 750November 8, 1999
Medicare Competitive Pricing: Lessons Being Learned in Phoenix and Kansas City
Author: Nora Super

Forum SessionNovember 8, 1999
Medicare Competitive Pricing: Lessons Being Learned in Phoenix and Kansas City
Manager: Nora Super

Issue Brief  No. 749October 27, 1999
The ABCs of PBMs
Author: Robin J. Strongin

Forum SessionOctober 27, 1999
The ABCs of PBMs
Manager: Robin J. Strongin

Issue Brief  No. 744July 13, 1999
Access to Home Health Services under Medicare's Interim Payment System
Author: Nora Super

Forum SessionJuly 13, 1999
Access to Home Health Services under Medicare's Interim Payment System
Manager: Nora Super

Issue Brief  No. 743July 7, 1999
Implementing the BBA: The Challenge of Moving Medicare Post-Acute Services to PPS
Author: Karen Matherlee

Forum SessionJuly 7, 1999
Implementing the BBA: The Challenge of Moving Medicare Post-Acute Services to PPS
Manager: Karen Matherlee

Issue Brief  No. 742June 25, 1999
Canada's Generalist Training: Are There Lessons for the United States?
Author: Lee A. Hawkins, Consultant

Forum SessionJune 25, 1999
Canada's Generalist Training: Are There Lessons for the United States?
Manager: Lee A. Hawkins, Consultant

Forum SessionApril 8, 1999
Providing Outpatient Prescription Drugs through Medicare: Can We Afford To? Can We Afford Not To?
Manager: Robin J. Strongin

Issue Brief  No. 734March 30, 1999
Margins As Measures: Gauging Hospitals' Financial Health
Author: Karen Matherlee

Forum SessionMarch 30, 1999
Margins As Measures: Gauging Hospitals' Financial Health
Manager: Karen Matherlee

Issue Brief  No. 733March 24, 1999
Examining the Links between Retirement and Health Insurance: Implications for Medicare Eligibility
Author: Nora Super

Forum SessionMarch 24, 1999
Examining the Links between Retirement and Health Insurance: Implications for Medicare Eligibility
Manager: Nora Super

Background Paper  March 1999
Providing Outpatient Prescription Drugs through Medicare: Can We Afford To? Can We Afford Not To?
Author: Robin J. Strongin

Issue Brief  No. 730February 5, 1999
Medicare HMO Pullouts: What Do They Portend for the Future of Medicare+Choice?
Author: Nora Super

Forum SessionFebruary 5, 1999
Medicare HMO Pullouts: What Do They Portend for the Future of Medicare+Choice?
Manager: Nora Super

Issue Brief  No. 729January 25, 1999
Filling the Geriatric Gap: Is the Health System Prepared for an Aging Population?
Author: Janet Firshein, Consultant

Forum SessionJanuary 25, 1999
Filling the Geriatric Gap: Is the Health System Prepared for an Aging Population?
Managers: Janet Firshein, Consultant & Nora Super

Site VisitNovember 17–20, 1998
Site Visit to Southern California — Plans and Providers: Risk, Accountability, and Staying Power
Authors: Lisa Sprague & Sandra M. Foote

Issue Brief  No. 723July 24, 1998
Communicating to Beneficiaries about Medicare+Choice: Opportunities and Pitfalls
Author: Nora Super

Forum SessionJuly 24, 1998
Communicating to Beneficiaries about Medicare+Choice: Opportunities and Pitfalls
Managers: Nora Super & Sandra M. Foote

Issue Brief  No. 722July 9, 1998
Medicare Coverage and Technology Diffusion: Past, Present, and Future
Author: Robin J. Strongin

Forum SessionJuly 9, 1998
Medicare Coverage and Technology Diffusion: Past, Present, and Future
Manager: Robin J. Strongin

Issue Brief  No. 648May 6, 1994
Federal Support of Medical Education: Framing the Issues for the Systems Reform Debate
Author: Karen Matherlee


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