Level 2: Medicare Coverage Rules

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• Course 1: Medicare Part A (Hospital Insurance)

  $20.00 for 1 year Start Course
  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 2: Medicare Advantage Appeals

  $20.00 for 1 year Start Course
  In 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 3: Medicare Part D Appeals

  $20.00 for 1 year Start Course
  This 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.

• Course 4: Enrollment Periods

  $20.00 for 1 year Start Course
  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.