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Course 1: Medicare and Employer Insurance

Coordination of benefits is the term used to describe how Medicare works with other kinds of insurance, including employer insurance and Medicaid. In this course, you will learn about the coordination of benefits rules for current and former employer coverage, including COBRA, retiree coverage, and Federal Employee Health Benefits (FEHB). You will find out if Medicare pays primary or secondary to different employer-related insurance, depending on the number of employees and whether individuals are eligible for Medicare due to age or disability. You will also gain valuable knowledge about various enrollment-related consequences and considerations for beneficiaries who delay their Medicare enrollment.

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  • 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.

  • 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 4: Medigaps

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    This course focuses on Medigaps, also known as supplemental insurance plans or policies, which work with Original Medicare and pay some or all of the costs that Medicare does not cover, such as deductibles, coinsurance, and copayments. You will learn about the 10 different standardized Medigap policies, labeled A through N, and explore how different lettered plans may offer different levels of coverage, but all plans under the same letter—regardless of the insurer issuing them—must offer the same level of coverage. You’ll see how premium costs can vary widely from insurer to insurer, depending on if the plan uses community-rated, attained-age-rated, or issue-age-rated pricing. Finally, you will find out when an individual can purchase a Medigap and learn about the guaranteed issue right.

  • 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.
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