Who is eligible for Medicare?

Most people know that in the U.S., all Americans (i.e., citizens or permanent residents) are eligible for Medicare once they turn 65.  However, the benefits are not the same for all individuals.  For instance, the following groups can receive Part A Medicare coverage without paying a premium: Individuals who already get retirement benefits from Social…

Incentives for Long-term Care Facilities to Hospitalize Patients

Why are hospitalization rates so high for Medicare beneficiaries living in long-term care facilities (i.e., skilled nursing facilities, nursing facilities, and assisted living facilities)?  The first reason is obvious: they are sick.  If they weren’t, they wouldn’t need to be living in these facilities in the first place.  Hospitalizing sick patients is often necessary.  Unnecessary…

How Medicare payment policy affects SNF incentives to hospitalize patients

Under Medicare Part A, beneficiaries can receive coverage for care provided by skilled nursing facilities (SNFs), also known as nursing homes.  Between 2000 and 2007, however, the rate of potentially avoidable re-hospitalizations for five key conditions (congestive heart failure, respiratory infection, urinary tract infection, sepsis, and electrolyte imbalance) increased from 13.7% to 18.5%. One potential explanation…

Safety Net Patients in California

The California Health Care Foundation (CHCF) reviews how California’s safety net residents receive medical care.  Safety Net patients are considered those who have incomes below 300% of the federal poverty line.  Below is a list of governmental and non-governmental programs which serve California Safety Net residents. State: Medi-cal (California’s Medicaid program) and Healthy Families (California’s CHIP…