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Medicare Interactive Pro

The Medicare Rights Center is the national, nonprofit consumer service organization that powers MI Pro, the online curriculum designed to empower any professional to better help their clients, patients, employees, retirees, and others navigate a multitude of Medicare questions. Medicare Rights is the largest and most reliable independent source of Medicare information and assistance in the United States.

MI Pro is structured as a four-level Core Curriculum, with four to five interactive courses in each level.


Medicare Interactive Pro

Level 1: Medicare Basics

1 Year Subscription
$75 CSAs / $90 non-CSAs

Level 1: Medicare Basics

This course includes:

Health Insurance Terms

Medicare Overview

Medicare Options

Enrollment Periods

Course Description:

This level serves as a gateway to understanding Medicare. Throughout introductory MI Pro Level 1 courses, you will learn common insurance and health care terms, gain an understanding of Medicare eligibility requirements, and receive a broad overview of the fundamental components of Medicare. Read More


1.1 - Health Insurance Terms

This course marks the beginning of your journey in navigating the world of Medicare. First you will become familiar with health insurance terms and concepts that are essential to understanding Medicare. You will use this vocabulary to access and describe more complicated topics as we move through the MI Pro core curriculum. Terms and concepts we’ll cover include premiums, deductibles, coinsurances, copayments; distinctions between private and public health insurance; the three categories of providers for Original Medicare; differences between in-network and out-of-network for Medicare Advantage Plans; non-doctor types of health care providers; differences between hospital inpatients and outpatients; kinds of Medicare-covered therapy and types of care; and important notices that Medicare beneficiaries will receive before or after receiving a health care service or item.

After taking this course, you will be able to:

  • • Understand common health insurance terms.

  • • Use those terms to talk about Medicare with clients, patients, and loved ones.


1.2 - Medicare Overview

Medicare is a complex and evolving program. This course provides a basic introduction to this health insurance program for individuals 65 and older and people with certain disabilities, with a look into the different parts of the program. You’ll learn how Medicare can be administered publicly (Original Medicare) or privately (Medicare Advantage) and explore program eligibility rules for individuals due to age or disability, including coverage for individuals with ALS and End-Stage Renal Disease. We’ll also review the roles of the Social Security Administration and the Centers for Medicare & Medicaid Services, and see how the Medicare and Medicaid programs can work together.

After taking this course, you will be able to:

  • • Understand Medicare’s history and background.

  • • Explain the basics of Medicare

  • • List the different parts of Medicare, and discuss rules for what makes someone eligible for Medicare.

  • • Discuss the main differences between Medicare and another government-run program, Medicaid.


1.3 - Medicare Options

In this course, you will learn how to make an informed decision about Medicare coverage, first by learning the two different ways that Medicare benefits are offered: through Original Medicare administered directly through the federal government and through Medicare Advantage Plans offered by private insurance companies that contract with the federal government. We will talk about the broad categories of care, program costs, and excluded services under Original Medicare, and then see how Medicare Advantage Plans must cover all the same services, but may do so with different costs, restrictions, and additional benefits. You will also learn about Medigap supplemental policies and public benefits available to help those with lower incomes afford care.

After taking this course, you will be able to:

  • • Identify the two main ways an individual can receive their Medicare benefits.

  • • Describe the differences between Original Medicare and Medicare Advantage Plans.

  • • Help beneficiaries decide which Medicare option works best for them.


1.4 - Enrollment Periods

This course focuses on important Medicare enrollment periods, which are times during the year when an individual can sign up for Medicare for the first time or make changes to existing Medicare coverage. We will also review the penalties that one can incur for not enrolling in Medicare when first eligible, underscoring the importance of making timely Medicare decisions and helping individuals consider their coverage options. Enrollment periods covered in this course include the Initial Enrollment Period, General Enrollment Period, Special Enrollment Period, and Fall Open Enrollment Period.

After taking this course, you will be able to:

  • • Differentiate between first-time enrollment periods and times during the year when individuals can change their existing coverage.

  • • Understand when an individual may have a Special Enrollment Period.

  • • Identify circumstances under which an individual may incur a late enrollment penalty.

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Level 2: Medicare Options

1 Year Subscription
$95 CSAs / $110 non-CSAs

Level 2: Medicare Options

This course includes:

Medicare Part A (Hospital Insurance)

Medicare Part B (Medical Insurance)

Medicare Part D (Prescription Drug Benefit)

Medigaps

Medicare Advantage Plans

Course Description:

This level expands on baseline Medicare knowledge and elaborates on specific coverage rules for Medicare Parts A, B, C, and D. Throughout MI Pro Level 2 courses, you will secure a better understanding of Medicare enrollment periods and Medicare coverage rules, and learn important differences between Original Medicare and Medicare Advantage Plans. Read More


2.1 - Medicare Part A (Hospital Insurance)

In this course, you will learn about the coverage and costs under Original Medicare Part A, also known as hospital insurance. You will learn about key areas of Part A coverage: inpatient hospital care, skilled nursing facility care, home health care, and hospice care. We’ll also explore cost components for Part A, including what constitutes premium-free Part A for beneficiaries or their spouses based on work history, what determines a benefit period and how the Part A deductible applies to each period, and how coinsurances may apply for Part A-covered services, depending on what type of service is received.

After taking this course, you will be able to:

  • • Identify the services Part A covers.

  • • Understand when Part A will cover those services.

  • • Explain the three Part A costs: premiums, deductibles, and coinsurances.


2.2 - Medicare Part B (Medical Insurance)

In this course, you will learn about the coverage and costs under Original Medicare Part B, also known as medical insurance. You will learn about key areas of Part B coverage: outpatient care, doctors’ services, preventive care, home health care, and durable medical equipment. We’ll also explore how the Centers for Medicare & Medicaid Services set the Part B premium and deductible each year. Finally, we’ll talk about how copays/coinsurances vary depending on the type of service a beneficiary receives and whether the provider is a participating, non-participating, or opt-out provider.

After taking this course, you will be able to:

  • • Identify the services Part B covers.

  • • Understand when Part B will cover those services.

  • • Explain the three Part B costs: premiums, deductibles, and coinsurances.


2.3 - Medicare Part D (Prescription Drug Benefit)

This course addresses Medicare Part D, the part of Medicare that covers most outpatient prescription drugs either through a stand-alone Part D plan or included in a Medicare Advantage Plan. You will learn how each Part D plan covers different drugs on its formulary, take a closer look at the drugs Part D and Part B cover, and find out which drugs are excluded from Medicare coverage. The course also details the cost structure of Part D plans, particularly the way premiums, deductibles, and copay/coinsurance amounts can vary, depending on the plan. We provide detailed explanations and examples to illustrate the four different phases of Part D coverage in any given calendar year: the deductible phase, the initial coverage period, the donut hole or coverage gap, and catastrophic coverage. We will also explore common coverage restrictions, including prior authorization, quantity limits, and step therapy. Finally, we’ll introduce Medicare Plan Finder, an online tool that helps individuals compare and find a Part D plan that works for them.

After taking this course, you will be able to:

  • • Identify which types of drugs Part D does and does not cover.

  • • Understand Part D costs and coverage throughout the year.

  • • Explain coverage restrictions that Part D plans can place on covered drugs.

  • • Use Plan Finder to choose a drug plan.


2.4 - Medigaps

This course focuses on Medigaps, also known as supplemental insurance plans or policies, which work with Original Medicare and pay some or all of the costs that Medicare does not cover, such as deductibles, coinsurance, and copayments. You will learn about the 10 different standardized Medigap policies, labeled A through N, and explore how different lettered plans may offer different levels of coverage, but all plans under the same letter—regardless of the insurer issuing them—must offer the same level of coverage. You’ll see how premium costs can vary widely from insurer to insurer, depending on if the plan uses community-rated, attained-age-rated, or issue-age-rated pricing. Finally, you will find out when an individual can purchase a Medigap and learn about the guaranteed issue right.

After taking this course, you will be able to:

  • • Explain what a Medigap is.

  • • Determine when a beneficiary has the right to buy a Medigap.

  • • Identify the different types of Medigaps.


2.5 - Medicare Advantage Plans

This course addresses the basics of Medicare Advantage (MA) Plans, a private insurance alternative to Original Medicare that must cover the same baseline benefits as Original Medicare. We’ll see how MA Plans can use networks of providers and service areas, require referrals for specialists, include additional benefits not covered by Original Medicare, and affect a beneficiary’s out-of-pocket costs. You’ll learn about several different types of Medicare Advantage Plan, such as health maintenance organizations and Special Needs Plans, and find out the services that plans must cover and how they may charge different costs or impose different terms than Original Medicare. Finally, we’ll explore beneficiary rights and protections in MA Plans and how these are enforced through grievances and appeals.

After taking this course, you will be able to:

  • • Explain how Medicare Advantage is different from Original Medicare.

  • • Identify the main types of Medicare Advantage Plans.

  • • Understand the basics of what Medicare Advantage Plans cover, and at what costs.

  • • Discuss how and when to file a formal complaint, called a grievance.

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Level 3: Appeals and Penalties

1 Year Subscription
$75 CSAs / $90 non-CSAs

Level 3: Appeals and Penalties

This course includes:

Original Medicare Appeals

Medicare Advantage Appeals

Medicare Part D Appeals

Medicare Late Enrollment Penalties and IRMAA

Course Description:

This level offers students more familiar with Medicare the information and skills needed to assist Medicare beneficiaries in appealing denials of coverage and navigating issues related to Medicare premium penalties. Throughout advanced MI Pro Level 3 courses, you will learn more about the different types of Medicare appeals and the steps necessary to successfully navigate the appeals process. Read More


3.1 - Original Medicare Appeals

A person with Medicare will file different types of appeals depending on the type of service they receive and the type of coverage they have. In this course, we will talk about Original Medicare appeals, which beneficiaries may file if they are denied a health care service or item and think that it should be covered. You will learn about the five steps of filing a standard appeal and also how to file an expedited appeal for hospital and non-hospital care.

After taking this course, you will be able to:

  • • Identify when a beneficiary may start an Original Medicare appeal.

  • • Explain the difference between Original Medicare standard and expedited appeals.

  • • Navigate expedited appeals for ending hospital care and ending non-hospital care.

  • • Understand the steps in the different Original Medicare appeal processes.


3.2 - Medicare Advantage Appeals

In this course, you will learn about Medicare Advantage (MA) appeals, or appeals beneficiaries make to their Medicare Advantage Plan if the plan is denying a health care service or item that they would like to receive or have already received. You will learn about standard appeals for both pre-service and post-service denials. We will also review standard and expedited appeals and their applicable timelines.

After taking this course, you will be able to:

  • • Identify when a beneficiary may start a Medicare Advantage appeal.

  • • Explain the difference between Medicare Advantage standard and expedited appeals.

  • • Navigate expedited appeals for ending hospital care and ending non-hospital care.

  • • Understand the steps in the different Medicare Advantage appeal processes.


3.3 - Medicare Part D Appeals

This course guides you through the Medicare Part D appeals process, which is the same whether a person has a stand-alone Part D plan (PDP) or a Medicare Advantage Plan with prescription drug coverage (MAPD). We will review the reasons beneficiaries might want to appeal, including the drug they need is not covered by their plan, the drug is covered but there are coverage restrictions on the drug, or the drug is covered but they want to request a tiering exception in order to pay a lower copay. You will learn the specifics of the first pre-appeal step, and then we will detail the five levels of appeal within both standard and expedited timeframes. You will gain valuable tips to help people with Medicare move effectively through the appeal process, such as how to properly complete paperwork and how to enlist a doctor to support your appeal.

After taking this course, you will be able to:

  • • Identify when a beneficiary may start a Part D appeal.

  • • Explain the difference between Part D standard and expedited appeals.

  • • Understand the steps in the Part D appeal process.


3.4 - Medicare Late Enrollment Penalties and IRMAA

Many beneficiaries have questions about late enrollment penalties and Medicare Income-Related Monthly Adjustment Amounts (IRMAA), and this course will help people with Medicare avoid penalties wherever possible. You will learn that penalties are incurred if individuals do not enroll in Medicare Parts A, B, and/or D when they are first eligible to do so, and we will explore how these penalties may be eliminated. The course reviews all key IRMAA considerations: what IRMAA is, when it must be paid and who is likely to pay it, and how to appeal or request a new initial determination if there is disagreement with Social Security’s IRMAA decision.

After taking this course, you will be able to:

  • • Explain Medicare late enrollment penalties.

  • • Identify situations when a beneficiary would incur a late enrollment penalty.

  • • Understand how beneficiaries can avoid and eliminate late enrollment penalties.

  • • Talk about Income-Related Monthly Adjustment Amounts, or IRMAA.

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Level 4: Other Insurance and Assistance Programs

1 Year Subscription
$75 CSAs / $90 non-CSAs

Level 4: Other Insurance and Assistance Programs

This course includes:

Medicare and Employer Insurance

Medicare and Other Insurance

Medicare and Medicaid

Medigaps

Medicare Assistance Programs

Course Description:

This level provides advanced students with in-depth information on how Medicare works with other types of insurances, and how to navigate enrollment into low-income assistance programs. Throughout advanced MI Pro Level 4 courses, you will learn about Medicare coordination of benefits and how to screen Medicare beneficiaries for low-income assistance programs. Read More


4.1 - Medicare and Employer Insurance

Coordination of benefits is the term used to describe how Medicare works with other kinds of insurance, including employer insurance and Medicaid. In this course, you will learn about the coordination of benefits rules for current and former employer coverage, including COBRA, retiree coverage, and Federal Employee Health Benefits (FEHB). You will find out if Medicare pays primary or secondary to different employer-related insurance, depending on the number of employees and whether individuals are eligible for Medicare due to age or disability. You will also gain valuable knowledge about various enrollment-related consequences and considerations for beneficiaries who delay their Medicare enrollment.

After taking this course, you will be able to:

  • • Explain what coordination of benefits means and differentiate between primary and secondary insurance.

  • • Determine when a beneficiary’s current employer insurance pays primary or secondary to Medicare.

  • • Understand how COBRA insurance, retiree insurance, and Federal Employee Health Benefits (FEHB) coordinate with Medicare.

  • • Discuss the consequences of a beneficiary delaying Medicare enrollment.


4.2 - Medicare and Other Insurance

This course explores coordination of benefits rules for military and non-employer insurance, as well as other types of insurance a beneficiary may have. We will address TRICARE, TRICARE for Life, and Veterans Affairs (VA) benefits, and see how each coordinates—or does not coordinate—with Medicare. This course also includes discussions of liability insurance, no-fault insurance, and workers’ compensation, including information about how all of these pay primary or secondary to Medicare. We will also discuss what happens when Medicare makes a conditional payment and the steps involved in the conditional payment recovery process. Finally, we will take a look at long-term care insurance, dental insurance, and Health Insurance Marketplace plans and what must happen when an individual with Marketplace coverage becomes Medicare-eligible.

After taking this course, you will be able to:

  • • Understand how military benefits coordinate with Medicare, including TRICARE, TRICARE for Life, and Veterans Affairs (VA) Benefits.

  • • Explain how liability insurance, no-fault insurance, and workers’ compensation work with Medicare.

  • • Discuss the basics of long-term care and dental insurance.

  • • Recognize how Health Insurance Marketplaces may affect Medicare beneficiaries.


4.3 - Medicare and Medicaid

In this course, you will learn about the Medicaid program in more detail and how it affects lower-income Medicare beneficiaries. We will explore the basics of Medicaid, including eligibility and state-specific rules. Specifically, you will find out how individuals can qualify for Medicaid in some states by taking advantage of a Medicaid spend-down, participating in a trust program, or enrolling through the Medicaid Buy-In program. You will learn about Medicaid coverage, including mandatory and optional benefits, and go into detail about Institutional Medicaid and Medicaid waiver programs for beneficiaries who need long-term care. The course will also introduce MAGI (Modified Adjusted Gross Income) Medicaid, including Medicaid for expansion populations under the Affordable Care Act (ACA), available to individuals with higher income limits than traditional Medicaid. You will also find out how individuals transition from MAGI Medicaid to Medicare and possible outcomes.

After taking this course, you will be able to:

  • • Explain what Medicaid is and what makes someone eligible.

  • • Understand how to apply for Medicaid.

  • • Discuss the services Medicaid covers.

  • • Help beneficiaries transition among different types of Medicaid.


4.4 - Medicare Assistance Programs

In this course, we will address the various federal and state programs available to help beneficiaries pay for their Medicare costs: Medicare Savings Programs, including the Qualifying Individual (QI), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Medicare Beneficiary (QMB) programs; Extra Help; Medicare’s Limited Income Newly Eligible Transition program (LI NET); State Pharmaceutical Assistance Programs (SPAPs); and Patient Assistance Programs (PAPs). You will find out how each of these programs works and the Medicare costs each is designed to help cover. You will also learn more about the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which helps ensure that beneficiaries who apply for one benefit are screened for and, where possible, enrolled in other programs for which they might be eligible.

After taking this course, you will be able to:

  • • Discuss Medicare Savings Programs and how to screen for them.

  • • Understand the federal Extra Help drug subsidy.

  • • Seek out state-specific assistance programs.

  • • Help beneficiaries apply for an array of programs.

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Medicare Intensive

1 Year Subscription
$320 CSAs / $360 non-CSAs

Medicare Intensive Course

This course includes:

Level 1: Medicare Basics

Level 2: Medicare Options

Level 3: Appeals and Penalties

Level 4: Other Insurance and Assistance Programs

Course Description:

Professionals wanting in-depth knowledge of the rules and regulations regarding Medicare will find this 17-module Intensive program useful to help clients navigate the Medicare maze. Topics covered include health insurance terms, a Medicare program overview, options for coverage, enrollment periods, dissection of Medicare Parts A, B, and D, Medigaps, Medicare Advantage Plans, Original Medicare appeals, Medicare Advantage appeals, Part D appeals, Medicare Late Enrollment Penalties, IRMAA, Medicare and the coordination of benefits with employer insurance and other types of insurance, Medicare and Medicaid, and Medicare Assistance Programs. Read More


1.1 - Health Insurance Terms

This course marks the beginning of your journey in navigating the world of Medicare. First you will become familiar with health insurance terms and concepts that are essential to understanding Medicare. You will use this vocabulary to access and describe more complicated topics as we move through the MI Pro core curriculum. Terms and concepts we’ll cover include premiums, deductibles, coinsurances, copayments; distinctions between private and public health insurance; the three categories of providers for Original Medicare; differences between in-network and out-of-network for Medicare Advantage Plans; non-doctor types of health care providers; differences between hospital inpatients and outpatients; kinds of Medicare-covered therapy and types of care; and important notices that Medicare beneficiaries will receive before or after receiving a health care service or item.

After taking this course, you will be able to:

  • • Understand common health insurance terms.

  • • Use those terms to talk about Medicare with clients, patients, and loved ones.


1.2 - Medicare Overview

Medicare is a complex and evolving program. This course provides a basic introduction to this health insurance program for individuals 65 and older and people with certain disabilities, with a look into the different parts of the program. You’ll learn how Medicare can be administered publicly (Original Medicare) or privately (Medicare Advantage) and explore program eligibility rules for individuals due to age or disability, including coverage for individuals with ALS and End-Stage Renal Disease. We’ll also review the roles of the Social Security Administration and the Centers for Medicare & Medicaid Services, and see how the Medicare and Medicaid programs can work together.

After taking this course, you will be able to:

  • • Understand Medicare’s history and background.

  • • Explain the basics of Medicare

  • • List the different parts of Medicare, and discuss rules for what makes someone eligible for Medicare.

  • • Discuss the main differences between Medicare and another government-run program, Medicaid.


1.3 - Medicare Options

In this course, you will learn how to make an informed decision about Medicare coverage, first by learning the two different ways that Medicare benefits are offered: through Original Medicare administered directly through the federal government and through Medicare Advantage Plans offered by private insurance companies that contract with the federal government. We will talk about the broad categories of care, program costs, and excluded services under Original Medicare, and then see how Medicare Advantage Plans must cover all the same services, but may do so with different costs, restrictions, and additional benefits. You will also learn about Medigap supplemental policies and public benefits available to help those with lower incomes afford care.

After taking this course, you will be able to:

  • • Identify the two main ways an individual can receive their Medicare benefits.

  • • Describe the differences between Original Medicare and Medicare Advantage Plans.

  • • Help beneficiaries decide which Medicare option works best for them.


1.4 - Enrollment Periods

This course focuses on important Medicare enrollment periods, which are times during the year when an individual can sign up for Medicare for the first time or make changes to existing Medicare coverage. We will also review the penalties that one can incur for not enrolling in Medicare when first eligible, underscoring the importance of making timely Medicare decisions and helping individuals consider their coverage options. Enrollment periods covered in this course include the Initial Enrollment Period, General Enrollment Period, Special Enrollment Period, and Fall Open Enrollment Period.

After taking this course, you will be able to:

  • • Differentiate between first-time enrollment periods and times during the year when individuals can change their existing coverage.

  • • Understand when an individual may have a Special Enrollment Period.

  • • Identify circumstances under which an individual may incur a late enrollment penalty.

2.1 - Medicare Part A (Hospital Insurance)

In this course, you will learn about the coverage and costs under Original Medicare Part A, also known as hospital insurance. You will learn about key areas of Part A coverage: inpatient hospital care, skilled nursing facility care, home health care, and hospice care. We’ll also explore cost components for Part A, including what constitutes premium-free Part A for beneficiaries or their spouses based on work history, what determines a benefit period and how the Part A deductible applies to each period, and how coinsurances may apply for Part A-covered services, depending on what type of service is received.

After taking this course, you will be able to:

  • • Identify the services Part A covers.

  • • Understand when Part A will cover those services.

  • • Explain the three Part A costs: premiums, deductibles, and coinsurances.


2.2 - Medicare Part B (Medical Insurance)

In this course, you will learn about the coverage and costs under Original Medicare Part B, also known as medical insurance. You will learn about key areas of Part B coverage: outpatient care, doctors’ services, preventive care, home health care, and durable medical equipment. We’ll also explore how the Centers for Medicare & Medicaid Services set the Part B premium and deductible each year. Finally, we’ll talk about how copays/coinsurances vary depending on the type of service a beneficiary receives and whether the provider is a participating, non-participating, or opt-out provider.

After taking this course, you will be able to:

  • • Identify the services Part B covers.

  • • Understand when Part B will cover those services.

  • • Explain the three Part B costs: premiums, deductibles, and coinsurances.


2.3 - Medicare Part D (Prescription Drug Benefit)

This course addresses Medicare Part D, the part of Medicare that covers most outpatient prescription drugs either through a stand-alone Part D plan or included in a Medicare Advantage Plan. You will learn how each Part D plan covers different drugs on its formulary, take a closer look at the drugs Part D and Part B cover, and find out which drugs are excluded from Medicare coverage. The course also details the cost structure of Part D plans, particularly the way premiums, deductibles, and copay/coinsurance amounts can vary, depending on the plan. We provide detailed explanations and examples to illustrate the four different phases of Part D coverage in any given calendar year: the deductible phase, the initial coverage period, the donut hole or coverage gap, and catastrophic coverage. We will also explore common coverage restrictions, including prior authorization, quantity limits, and step therapy. Finally, we’ll introduce Medicare Plan Finder, an online tool that helps individuals compare and find a Part D plan that works for them.

After taking this course, you will be able to:

  • • Identify which types of drugs Part D does and does not cover.

  • • Understand Part D costs and coverage throughout the year.

  • • Explain coverage restrictions that Part D plans can place on covered drugs.

  • • Use Plan Finder to choose a drug plan.


2.4 - Medigaps

This course focuses on Medigaps, also known as supplemental insurance plans or policies, which work with Original Medicare and pay some or all of the costs that Medicare does not cover, such as deductibles, coinsurance, and copayments. You will learn about the 10 different standardized Medigap policies, labeled A through N, and explore how different lettered plans may offer different levels of coverage, but all plans under the same letter—regardless of the insurer issuing them—must offer the same level of coverage. You’ll see how premium costs can vary widely from insurer to insurer, depending on if the plan uses community-rated, attained-age-rated, or issue-age-rated pricing. Finally, you will find out when an individual can purchase a Medigap and learn about the guaranteed issue right.

After taking this course, you will be able to:

  • • Explain what a Medigap is.

  • • Determine when a beneficiary has the right to buy a Medigap.

  • • Identify the different types of Medigaps.


2.5 - Medicare Advantage Plans

This course addresses the basics of Medicare Advantage (MA) Plans, a private insurance alternative to Original Medicare that must cover the same baseline benefits as Original Medicare. We’ll see how MA Plans can use networks of providers and service areas, require referrals for specialists, include additional benefits not covered by Original Medicare, and affect a beneficiary’s out-of-pocket costs. You’ll learn about several different types of Medicare Advantage Plan, such as health maintenance organizations and Special Needs Plans, and find out the services that plans must cover and how they may charge different costs or impose different terms than Original Medicare. Finally, we’ll explore beneficiary rights and protections in MA Plans and how these are enforced through grievances and appeals.

After taking this course, you will be able to:

  • • Explain how Medicare Advantage is different from Original Medicare.

  • • Identify the main types of Medicare Advantage Plans.

  • • Understand the basics of what Medicare Advantage Plans cover, and at what costs.

  • • Discuss how and when to file a formal complaint, called a grievance.

3.1 - Original Medicare Appeals

A person with Medicare will file different types of appeals depending on the type of service they receive and the type of coverage they have. In this course, we will talk about Original Medicare appeals, which beneficiaries may file if they are denied a health care service or item and think that it should be covered. You will learn about the five steps of filing a standard appeal and also how to file an expedited appeal for hospital and non-hospital care.

After taking this course, you will be able to:

  • • Identify when a beneficiary may start an Original Medicare appeal.

  • • Explain the difference between Original Medicare standard and expedited appeals.

  • • Navigate expedited appeals for ending hospital care and ending non-hospital care.

  • • Understand the steps in the different Original Medicare appeal processes.


3.2 - Medicare Advantage Appeals

In this course, you will learn about Medicare Advantage (MA) appeals, or appeals beneficiaries make to their Medicare Advantage Plan if the plan is denying a health care service or item that they would like to receive or have already received. You will learn about standard appeals for both pre-service and post-service denials. We will also review standard and expedited appeals and their applicable timelines.

After taking this course, you will be able to:

  • • Identify when a beneficiary may start a Medicare Advantage appeal.

  • • Explain the difference between Medicare Advantage standard and expedited appeals.

  • • Navigate expedited appeals for ending hospital care and ending non-hospital care.

  • • Understand the steps in the different Medicare Advantage appeal processes.


3.3 - Medicare Part D Appeals

This course guides you through the Medicare Part D appeals process, which is the same whether a person has a stand-alone Part D plan (PDP) or a Medicare Advantage Plan with prescription drug coverage (MAPD). We will review the reasons beneficiaries might want to appeal, including the drug they need is not covered by their plan, the drug is covered but there are coverage restrictions on the drug, or the drug is covered but they want to request a tiering exception in order to pay a lower copay. You will learn the specifics of the first pre-appeal step, and then we will detail the five levels of appeal within both standard and expedited timeframes. You will gain valuable tips to help people with Medicare move effectively through the appeal process, such as how to properly complete paperwork and how to enlist a doctor to support your appeal.

After taking this course, you will be able to:

  • • Identify when a beneficiary may start a Part D appeal.

  • • Explain the difference between Part D standard and expedited appeals.

  • • Understand the steps in the Part D appeal process.


3.4 - Medicare Late Enrollment Penalties and IRMAA

Many beneficiaries have questions about late enrollment penalties and Medicare Income-Related Monthly Adjustment Amounts (IRMAA), and this course will help people with Medicare avoid penalties wherever possible. You will learn that penalties are incurred if individuals do not enroll in Medicare Parts A, B, and/or D when they are first eligible to do so, and we will explore how these penalties may be eliminated. The course reviews all key IRMAA considerations: what IRMAA is, when it must be paid and who is likely to pay it, and how to appeal or request a new initial determination if there is disagreement with Social Security’s IRMAA decision.

After taking this course, you will be able to:

  • • Explain Medicare late enrollment penalties.

  • • Identify situations when a beneficiary would incur a late enrollment penalty.

  • • Understand how beneficiaries can avoid and eliminate late enrollment penalties.

  • • Talk about Income-Related Monthly Adjustment Amounts, or IRMAA.

4.1 - Medicare and Employer Insurance

Coordination of benefits is the term used to describe how Medicare works with other kinds of insurance, including employer insurance and Medicaid. In this course, you will learn about the coordination of benefits rules for current and former employer coverage, including COBRA, retiree coverage, and Federal Employee Health Benefits (FEHB). You will find out if Medicare pays primary or secondary to different employer-related insurance, depending on the number of employees and whether individuals are eligible for Medicare due to age or disability. You will also gain valuable knowledge about various enrollment-related consequences and considerations for beneficiaries who delay their Medicare enrollment.

After taking this course, you will be able to:

  • • Explain what coordination of benefits means and differentiate between primary and secondary insurance.

  • • Determine when a beneficiary’s current employer insurance pays primary or secondary to Medicare.

  • • Understand how COBRA insurance, retiree insurance, and Federal Employee Health Benefits (FEHB) coordinate with Medicare.

  • • Discuss the consequences of a beneficiary delaying Medicare enrollment.


4.2 - Medicare and Other Insurance

This course explores coordination of benefits rules for military and non-employer insurance, as well as other types of insurance a beneficiary may have. We will address TRICARE, TRICARE for Life, and Veterans Affairs (VA) benefits, and see how each coordinates—or does not coordinate—with Medicare. This course also includes discussions of liability insurance, no-fault insurance, and workers’ compensation, including information about how all of these pay primary or secondary to Medicare. We will also discuss what happens when Medicare makes a conditional payment and the steps involved in the conditional payment recovery process. Finally, we will take a look at long-term care insurance, dental insurance, and Health Insurance Marketplace plans and what must happen when an individual with Marketplace coverage becomes Medicare-eligible.

After taking this course, you will be able to:

  • • Understand how military benefits coordinate with Medicare, including TRICARE, TRICARE for Life, and Veterans Affairs (VA) Benefits.

  • • Explain how liability insurance, no-fault insurance, and workers’ compensation work with Medicare.

  • • Discuss the basics of long-term care and dental insurance.

  • • Recognize how Health Insurance Marketplaces may affect Medicare beneficiaries.


4.3 - Medicare and Medicaid

In this course, you will learn about the Medicaid program in more detail and how it affects lower-income Medicare beneficiaries. We will explore the basics of Medicaid, including eligibility and state-specific rules. Specifically, you will find out how individuals can qualify for Medicaid in some states by taking advantage of a Medicaid spend-down, participating in a trust program, or enrolling through the Medicaid Buy-In program. You will learn about Medicaid coverage, including mandatory and optional benefits, and go into detail about Institutional Medicaid and Medicaid waiver programs for beneficiaries who need long-term care. The course will also introduce MAGI (Modified Adjusted Gross Income) Medicaid, including Medicaid for expansion populations under the Affordable Care Act (ACA), available to individuals with higher income limits than traditional Medicaid. You will also find out how individuals transition from MAGI Medicaid to Medicare and possible outcomes.

After taking this course, you will be able to:

  • • Explain what Medicaid is and what makes someone eligible.

  • • Understand how to apply for Medicaid.

  • • Discuss the services Medicaid covers.

  • • Help beneficiaries transition among different types of Medicaid.


4.4 - Medicare Assistance Programs

In this course, we will address the various federal and state programs available to help beneficiaries pay for their Medicare costs: Medicare Savings Programs, including the Qualifying Individual (QI), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Medicare Beneficiary (QMB) programs; Extra Help; Medicare’s Limited Income Newly Eligible Transition program (LI NET); State Pharmaceutical Assistance Programs (SPAPs); and Patient Assistance Programs (PAPs). You will find out how each of these programs works and the Medicare costs each is designed to help cover. You will also learn more about the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which helps ensure that beneficiaries who apply for one benefit are screened for and, where possible, enrolled in other programs for which they might be eligible.

After taking this course, you will be able to:

  • • Discuss Medicare Savings Programs and how to screen for them.

  • • Understand the federal Extra Help drug subsidy.

  • • Seek out state-specific assistance programs.

  • • Help beneficiaries apply for an array of programs.

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