This section 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 section, you will be able to:

• Understand common health insurance terms
• Use those terms to talk about Medicare with clients, patients, and loved ones

• Interactive activities and knowledge quizzes
• Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
• Educational content vetted by a team of national experts at Medicare Rights Center
• Closed captioning
• An array of printable supplementary tools and fliers

Medicare is a complex and evolving program. This section 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 section, 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

• Interactive activities and knowledge quizzes
• Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
• Educational content vetted by a team of national experts at Medicare Rights Center
• Closed captioning
• An array of printable supplementary tools and fliers

This section 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 section include the Initial Enrollment Period, General Enrollment Period, Special Enrollment Period, and Fall Open Enrollment Period.

After taking this section, 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/li>

• Interactive activities and knowledge quizzes
• Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
• Educational content vetted by a team of national experts at Medicare Rights Center
• Closed captioning
• An array of printable supplementary tools and fliers

In this section, 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 section, 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

• Interactive activities and knowledge quizzes
• Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
• Educational content vetted by a team of national experts at Medicare Rights Center
• Closed captioning
• An array of printable supplementary tools and fliers

In this section, 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 section, 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

• Interactive activities and knowledge quizzes
• Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
• Educational content vetted by a team of national experts at Medicare Rights Center
• Closed captioning
• An array of printable supplementary tools and fliers

This section 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 section 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 section, 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

• Interactive activities and knowledge quizzes
• Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
• Educational content vetted by a team of national experts at Medicare Rights Center
• Closed captioning
• An array of printable supplementary tools and fliers