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 3: Medicare and Medicaid
Start CourseIn 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 4: Medicare Assistance Programs
Start CourseIn this course, we will address the various federal and state programs available to help beneficiaries pay for their Medicare costs: Medicare Savings Programs, including the Qualifying Individual (QI), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Medicare Beneficiary (QMB) programs; Extra Help; Medicare’s Limited Income Newly Eligible Transition program (LI NET); State Pharmaceutical Assistance Programs (SPAPs); and Patient Assistance Programs (PAPs). You will find out how each of these programs works and the Medicare costs each is designed to help cover. You will also learn more about the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which helps ensure that beneficiaries who apply for one benefit are screened for and, where possible, enrolled in other programs for which they might be 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 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.
English