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 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 2: Medicare and Other Insurance
Start CourseThis course explores coordination of benefits rules for military and non-employer insurance, as well as other types of insurance a beneficiary may have. We will address TRICARE, TRICARE for Life, and Veterans Affairs (VA) benefits, and see how each coordinates—or does not coordinate—with Medicare. This course also includes discussions of liability insurance, no-fault insurance, and workers’ compensation, including information about how all of these pay primary or secondary to Medicare. We will also discuss what happens when Medicare makes a conditional payment and the steps involved in the conditional payment recovery process. Finally, we will take a look at long-term care insurance, dental insurance, and Health Insurance Marketplace plans and what must happen when an individual with Marketplace coverage becomes Medicare-eligible. -
Course 5: Medicare Advantage Plans
Start CourseThis 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: 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.
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