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 and Other Insurance

  $20.00 for 1 year Start Course
  This 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.

• Medicare and End-Stage Renal Disease (ESRD)

  $20.00 for 1 year Start Course
  This course provides information on Medicare for individuals with End-Stage Renal Disease (ESRD). ESRD Medicare has different rules than Medicare due to age or disability, and this course highlights those distinctions. In this course, you will learn about the eligibility, enrollment, and coverage rules for ESRD Medicare. The course also details the 30-month coordination period for ESRD Medicare beneficiaries. During this 30-month coordination period, there are specific rules regarding coordination of benefits for individuals with ESRD Medicare and employer coverage. Additionally, you will learn about coverage of ESRD treatments and immunosuppressant drugs. Finally, the course explores how Medicare Advantage plans, Part D plans, Medigap policies, and Health Insurance Marketplace plans work for individuals with ESRD Medicare.

• 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.