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Click on the links below to review the 8 modules in this program. Note: this Overview consists of 5 total hours of online learning content and up to 2 hours of knowledge quizzes and final review quizzes.
- Level 2: Medicare Coverage Rules
- Level 3: Medicare Appeals and Penalties
- Level 4: Other Insurance and Assistance Programs
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This course 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.
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Medicare is a complex and evolving program. This course 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.
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In this course, you will learn how to make an informed decision about Medicare coverage, first by learning the two different ways that Medicare benefits are offered: through Original Medicare administered directly through the federal government and through Medicare Advantage Plans offered by private insurance companies that contract with the federal government. We will talk about the broad categories of care, program costs, and excluded services under Original Medicare, and then see how Medicare Advantage Plans must cover all the same services, but may do so with different costs, restrictions, and additional benefits. You will also learn about Medigap supplemental policies and public benefits available to help those with lower incomes afford care.
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This course 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 course include the Initial Enrollment Period, General Enrollment Period, Special Enrollment Period, and Fall Open Enrollment Period.
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In this course, 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.
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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.
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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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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.
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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.
