Course 2: Medicare Advantage 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 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 1: Original Medicare Appeals

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  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.