Level 1: Medicare Basics

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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.

• Medicare Coverage of Durable Medical Equipment (DME)

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  This course provides important information on Medicare coverage of Durable Medical Equipment, or DME. In this course, you will become familiar with the definition of DME, according to Medicare rules. You will also learn Medicare coverage requirements that individuals must follow in order for Medicare to pay for DME they need. Additionally, you will learn about coverage rules for renting, buying, fixing, and replacing DME. Finally, the course will introduce you to the differences between Original Medicare and Medicare Advantage coverage of DME.

• Course 2: Medicare Advantage Appeals

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• Course 3: Medicare and Medicaid

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