Course 1: Original Medicare Appeals

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• Course 5: Medicare Advantage Plans

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  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.

• Course 3: Medicare and Medicaid

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  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.

• Course 2: Medicare Part B (Medical Insurance)

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  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.

• Course 1: Medicare Part A (Hospital Insurance)

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  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.