Medicare Complete includes the core curriculum levels 1-4 and all Special Topics courses.

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This level serves as a gateway to understanding Medicare. Throughout introductory MI Pro Level 1 courses, you will learn common insurance and health care terms, gain an understanding of Medicare eligibility requirements, and receive a broad overview of the fundamental components of Medicare. These courses are currently W3C WCAG 2.0 AA conformant.

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   Course 1: Health Insurance Terms Length: 40 minutes

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   This course marks the beginning of your journey in navigating the world of Medicare. First you will become familiar with health insurance terms and concepts that are essential to understanding Medicare. You will use this vocabulary to access and describe more complicated topics as we move through the MI Pro core curriculum. Terms and concepts we’ll cover include premiums, deductibles, coinsurances, copayments; distinctions between private and public health insurance; the three categories of providers for Original Medicare; differences between in-network and out-of-network for Medicare Advantage Plans; non-doctor types of health care providers; differences between hospital inpatients and outpatients; kinds of Medicare-covered therapy and types of care; and important notices that Medicare beneficiaries will receive before or after receiving a health care service or item.

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   Course 2: Medicare Overview Length: 40 minutes

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   Medicare is a complex and evolving program. This course provides a basic introduction to this health insurance program for individuals 65 and older and people with certain disabilities, with a look into the different parts of the program. You’ll learn how Medicare can be administered publicly (Original Medicare) or privately (Medicare Advantage) and explore program eligibility rules for individuals due to age or disability, including coverage for individuals with ALS and End-Stage Renal Disease. We’ll also review the roles of the Social Security Administration and the Centers for Medicare & Medicaid Services, and see how the Medicare and Medicaid programs can work together.

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   Course 3: Medicare Options Length: 40 minutes

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   In this course, you will learn how to make an informed decision about Medicare coverage, first by learning the two different ways that Medicare benefits are offered: through Original Medicare administered directly through the federal government and through Medicare Advantage Plans offered by private insurance companies that contract with the federal government. We will talk about the broad categories of care, program costs, and excluded services under Original Medicare, and then see how Medicare Advantage Plans must cover all the same services, but may do so with different costs, restrictions, and additional benefits. You will also learn about Medigap supplemental policies and public benefits available to help those with lower incomes afford care.

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   Course 4: Enrollment Periods Length: 40 minutes

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   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.

This level expands on baseline Medicare knowledge and elaborates on specific coverage rules for Medicare Parts A, B, C, and D. Throughout MI Pro Level 2 courses, you will secure a better understanding of Medicare enrollment periods and Medicare coverage rules, and learn important differences between Original Medicare and Medicare Advantage Plans.

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   Course 1: Medicare Part A (Hospital Insurance) Length: 55 minutes

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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.

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   Course 2: Medicare Part B (Medical Insurance) Length: 45 minutes

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   In this course, you will learn about the coverage and costs under Original Medicare Part B, also known as medical insurance. You will learn about key areas of Part B coverage: outpatient care, doctors’ services, preventive care, home health care, and durable medical equipment. We’ll also explore how the Centers for Medicare & Medicaid Services set the Part B premium and deductible each year. Finally, we’ll talk about how copays/coinsurances vary depending on the type of service a beneficiary receives and whether the provider is a participating, non-participating, or opt-out provider.

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   Course 3: Medicare Part D (Prescription Drug Benefit) Length: 55 minutes

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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.

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   Course 4: Medigaps Length: 45 minutes

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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.

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   Course 5: Medicare Advantage Plans Length: 1 hour

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   This 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.

This level offers students more familiar with Medicare the information and skills needed to assist Medicare beneficiaries in appealing denials of coverage and navigating issues related to Medicare premium penalties. Throughout advanced MI Pro Level 3 courses, you will learn more about the different types of Medicare appeals and the steps necessary to successfully navigate the appeals process.

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   Course 1: Original Medicare Appeals Length: 1 hour 15 minutes

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   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.

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   Course 2: Medicare Advantage Appeals Length: 1 hour 5 minutes

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   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.

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   Course 3: Medicare Part D Appeals Length: 45 minutes

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   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.

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   Course 4: Medicare Late Enrollment Penalties and IRMAA Length: 55 minutes

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   Many 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.

This level provides advanced students with in-depth information on how Medicare works with other types of insurances, and how to navigate enrollment into low-income assistance programs. Throughout advanced MI Pro Level 4 courses, you will learn about Medicare coordination of benefits and how to screen Medicare beneficiaries for low-income assistance programs.

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   Course 1: Medicare and Employer Insurance Length: 50 minutes

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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.

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   Course 2: Medicare and Other Insurance Length: 35 minutes

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   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.

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   Course 3: Medicare and Medicaid Length: 55 minutes

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   In this course, you will learn about the Medicaid program in more detail and how it affects lower-income Medicare beneficiaries. We will explore the basics of Medicaid, including eligibility and state-specific rules. Specifically, you will find out how individuals can qualify for Medicaid in some states by taking advantage of a Medicaid spend-down, participating in a trust program, or enrolling through the Medicaid Buy-In program. You will learn about Medicaid coverage, including mandatory and optional benefits, and go into detail about Institutional Medicaid and Medicaid waiver programs for beneficiaries who need long-term care. The course will also introduce MAGI (Modified Adjusted Gross Income) Medicaid, including Medicaid for expansion populations under the Affordable Care Act (ACA), available to individuals with higher income limits than traditional Medicaid. You will also find out how individuals transition from MAGI Medicaid to Medicare and possible outcomes.

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   Course 4: Medicare Assistance Programs Length: 45 minutes

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   In this course, we will address the various federal and state programs available to help beneficiaries pay for their Medicare costs: Medicare Savings Programs, including the Qualifying Individual (QI), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Medicare Beneficiary (QMB) programs; Extra Help; Medicare’s Limited Income Newly Eligible Transition program (LI NET); State Pharmaceutical Assistance Programs (SPAPs); and Patient Assistance Programs (PAPs). You will find out how each of these programs works and the Medicare costs each is designed to help cover. You will also learn more about the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which helps ensure that beneficiaries who apply for one benefit are screened for and, where possible, enrolled in other programs for which they might be eligible.

Special Topics courses address specific Medicare topics in detail. These courses will help you develop expertise in popular Medicare subject areas, such as the annual Medicare Fall Open Enrollment Period, effects of the Affordable Care Act (ACA) on Medicare, and Medicare coverage of specialty services. These courses are offered for single purchase, so that you can tailor your selections to your specific needs. Keep in mind that the Special Topics section of MI Pro continues to grow, so please check back to find new courses. Please also feel free to let us know of new courses that could help you in your work.

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   Medicare and End-Stage Renal Disease (ESRD) Length: 1 hour 15 minutes

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   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.

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   Medicare Coverage of Durable Medical Equipment (DME) Length: 40 minutes

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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.

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   Medicare Fall Open Enrollment Length: 20 minutes

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   This course provides an overview of Medicare Fall Open Enrollment, the time of year during which people with Medicare can make changes to their existing Medicare coverage. In this course, you will gain a better understanding of Medicare Fall Open Enrollment, learn about the important changes people with Medicare can make during this time, and find out how to most effectively take action to meet your health care needs.

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   Medicare Assistance Programs in New York Length: 1 hour 15 minutes

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   The information in this course applies to New York State only. For information about Medicare assistance programs on a national level, refer to Level 4, Course 4: Medicare Assistance Programs. This Special Topics Course provides detailed information about how Medicare beneficiaries in New York State can qualify for and enroll in programs to help save them money on their Medicare costs. You will learn how to screen and help clients apply for the Medicare Savings Program (MSP), Extra Help, and Elderly Pharmaceutical Insurance Coverage (EPIC).

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   Medicare and Military Health Benefits Length: 45 minutes

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   Veterans have unique health care options that may impact their Medicare enrollment decision making. To fully advise these clients, you need to know what types of Veterans Affairs or military health care coverage they have, and how those different types of coverage interact with Medicare. By the end of this course, you will be able to identify who may qualify for programs for Veterans, help Medicare-eligible Veterans determine their best coverage options, troubleshoot common enrollment issues that Veterans experience, and refer Veterans to appropriate resources for additional help.

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   WealthCare Connect’s Medicare Core Curriculum Length: minutes