Course 1: Original Medicare Appeals

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• Course 3: Medicare Part D Appeals

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  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.

• 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 3: Medicare Part D (Prescription Drug Benefit)

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  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.

• Course 4: Medicare Late Enrollment Penalties and IRMAA

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  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.