Related Experiment Video
Updated: Dec 10, 2025
A Metadata Extraction Approach for Clinical Case Reports to Enable Advanced Understanding of Biomedical Concepts
Published on: September 20, 2018
An Overview of Medicare for Clinicians
1Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. wge2n@hscmail.mcc.virginia.edu.
Background:
Medicare is estimated to cover 14% of the population of the USA (Henry J Kais Fam Found 2017), over fifty million people. Despite covering a smaller percentage of the population than employer-sponsored insurance and Medicaid, Medicare is the most common payer for inpatient encounters. The Healthcare Cost and Utilization Project estimated that in 2015, Medicare was the primary payer for 39.4% of hospitalizations (HCUP 2019). While in daily practice it may be practical to assume that patients eligible for Medicare are financially insulated from the costs of care, the reality is that no care exists in a vacuum. Medicare is a complex program that mitigates but does not completely eliminate costs to patients.
Objective:
This review aims to shed light for providers on the basics of Medicare, and how beneficiaries are impacted financially by their care to better understand some of the social barriers our patients face in seeking care.
Insights
Medicare, covering over 50 million Americans, is the primary payer for most hospitalizations. While it reduces costs, Medicare beneficiaries still face financial barriers to healthcare access.
Area of Science:
- Health Economics
- Public Health Policy
- Healthcare Access
Background:
- Medicare covers approximately 14% of the US population, over 50 million individuals.
- It is the leading payer for inpatient hospitalizations, accounting for 39.4% in 2015.
- Despite its coverage, Medicare does not fully eliminate patient costs, presenting financial challenges.
Purpose of the Study:
- To educate healthcare providers on Medicare basics.
- To explain the financial impact of healthcare costs on Medicare beneficiaries.
- To identify social barriers to care faced by patients.
Main Methods:
- Literature review of Medicare coverage and patient financial burden.
- Analysis of healthcare utilization data.
- Synthesis of information for provider education.
Main Results:
- Medicare is a significant payer for hospitalizations.
- Beneficiaries experience residual healthcare costs.
- Financial strain can act as a barrier to seeking care.
Conclusions:
- Understanding Medicare's financial implications is crucial for providers.
- Addressing patient cost-related barriers can improve healthcare access.
- Further insights into social determinants of health for Medicare enrollees are needed.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:19Standards of Care II
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:20Introduction to Documentation and Reporting
Nursing documentation records essential information and details regarding a patient's care and treatment in written or electronic form. It is a critical aspect of nursing practice that involves documenting assessments, interventions, outcomes, and other relevant details about a patient's health status.
Documentation maps the patient's health journey by creating a comprehensive...
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities