Course 2: Medicare Advantage Appeals

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• Course 1: Medicare Part A (Hospital Insurance)

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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.

• Course 1: Medicare and Employer Insurance

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  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.

• 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.

• 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.