Course 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.
Category: Uncategorized
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Course 4: Medicare Late Enrollment Penalties and IRMAA
Start CourseMany 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. -
Course 2: Medicare and Other Insurance
Start CourseThis 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. -
Course 2: Medicare Advantage Appeals
Start CourseIn 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. -
Course 3: Medicare Part D (Prescription Drug Benefit)
Start CourseThis 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.
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