The Medicare and Medicaid Guide—Highlights of All Explanations (White Paper)

Medicare is the single largest purchaser of health care in the United States, accounting for 23 percent ($522 billion) of the $2.3 trillion spent on health care in 2011, according to the Medicare Payment Advisory Commission. In 2012, Medicare covered 50.7 million people: 42.1 million aged 65 and older, and 8.5 million disabled, according to the 2013 Medicare Trustees Report. In 2011, Medicare paid for 27 percent of all hospital care, 23 percent of physician services, 44 percent of home health services, 25 percent of nursing home care, 20 percent of durable medical equipment, and 24 percent of prescription drugs.

Medicaid provides coverage for 58 million people, and accounts for 16 percent of all health care spending. With the expansion of Medicaid eligibility provided under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), Medicaid spending will continue to grow.

According to the Congressional Budget Office, the share of gross domestic product (GDP) devoted to federal health care spending will almost double in the next 25 years, from 4.6 percent of GDP in 2013 to 8 percent of GDP in 2038. With one-third of the U.S. population receiving health coverage through either Medicare or Medicaid, it will continue to be important for health care providers and practitioners, the legal and business advisors who support them, the legislators who pass laws amending the programs, and the administrators who regulate the programs, to stay on top of changes in the programs.

The Medicare and Medicaid Guide has been published since 1969. Available both in print and online, the Guide offers daily updates of new laws, regulations, court decisions, administrative decisions, and other guidance about these two health programs, in addition to over 500 explanations about how these programs work. The explanations cover all areas of both programs – who is eligible to get coverage; who is eligible to provide coverage; what types of services are covered; how the programs are financed and administered; how the government monitors fraud and abuse in the programs; just to name a few subject areas.

Wolters Kluwer editors have prepared a white paper which includes summaries of each explanation section of the Medicare and Medicaid Guide. It is designed as a supplement to what current subscribers of the Guide already receive with their subscriptions, but it can also be used as an introduction to the product for non-customers.

The complexity of the Medicare and Medicaid programs is often commented upon by judges when they write decisions based on the programs’ laws, regulations and other guidance. This overview highlights the complexity, but also provides a hint at the breadth of coverage in this product.