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 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 1: Medicare and Employer Insurance
Start CourseCoordination 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. -
Course 4: Medigaps
Start CourseThis 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 Appeals
Start CourseThis 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.
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