Medicare Advantage & Other Medicare Health Plans

Statement of Knowledge, skills and abilities the license is expected to obtain through the completion of this course:

This course is designed to offer a thorough orientation with regards to Medicare health plans options other than original Medicare, including an understanding of Medicare Advantage plans and Part D Prescription Drug coverage. The course offers a general introduction to Medicare Advantage plans (MA) and expands into the different types of Medicare health plans. Additionally, it covers topics on appeals, protections and rights for Medicare users. It explains how Medicare-related products must be marketed as well as the sales and marketing practices that are prohibited.

The course thoroughly prepares MA agents for a clear understanding of eligibility requirements for enrollments, suitability and compliant plan prospecting.

 This is an introductory course that will cover very important material in 3 hours, so it is not expected to provide in-depth coverage of the topics.

Students will get basic knowledge to demonstrate an understanding of the types of consumer options available, and the role the law envisions for agents and brokers in this highly regulated environment.

The types of Networks and the cost structure of Medicare plans will also be presented in the course, so it is expected that licenses will have the capacity to explain those concepts to.

Detailed outline of the course showing approximate times for major topics:

 

Topic

Minutes

1

Medicare Advantage & Other Medicare Health Plans

2

2

Contents

2

3

Session Objectives

2

4

Lesson 1—Introduction to
Medicare Advantage (MA)

3

5

Medicare Advantage (MA) Plans

3

6

Plan for Medicare Health Maintenance
Organization (HMO)

3

7

Plan for Medicare Preferred Provider
Organization (PPO)

3

8

Special Needs Plans (SNPs) for Medicare

7

9

Medicare Plan Private Fee-for-Service (PFFS)

7

10

Plans for Medicare and Medical Savings Account
 (MSA)

3

11

This is how Medicare Advantage (MA) works

3

12

Plan costs for Medicare Advantage (MA)

3

13

Who Can you be eligible for Joining a Medicare Advantage Plan?

3

14

End-Stage Renal Disease (ESRD) and 
Medicare Advantage (MA) Plans

3

15

Enrollment period for
Medicare Advantage (MA) Plans

3

16

Medicare Advantage Open Enrollment Period (MA OEP)

3

17

Join or Switch MA Plans—
5-Star Special Enrollment Period (SEP)

7

18

Drug Plan for Low Performing

3

19

Trial Rights and Medigap for
Medicare Advantage (MA)

3

20

Network Changes for Medicare Advantage
 (MA) Plan

3

21

Check Your Knowledge—Question 1

2

22

Check Your Knowledge—Question 2

2

23

Lesson 2—Different Medicare Health Plans

3

24

Different Medicare Health Plans

3

25

Costs for Medicare Plans

3

26

Cost for Medicare Plans—Non-renewals

3

27

Non-Renewal Reminder Notice for
Non-Renewing Cost Plan

3

28

Projects and Pilot Programs

3

29

All-inclusive Care
for the Elderly (PACE) Program Plans

3

30

Check Your Knowledge—Question 3

2

31

Lesson 3—Appeals, Protections, and Rights

3

32

Secure Rights

3

33

Medicare Health Plans Rights

3

34

Medicare Advantage (MA) Appeals and
Other Health Plans

3

35

Appeals Process for Medicare Advantage (Part C)

3

36

Medicare Health Plan Rights When You File an Appeal

3

37

Lesson 4—Guidelines for Medicare Marketing

3

38

Marketing Tools

3

39

Reminders

3

40

Plan Information for
New and Renewing Members

3

41

Changes to the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)

3

42

Gift Reminders

2

43

Unasked Beneficiary Contact

2

44

Prohibition for Cross-Selling

2

45

Appointment Reminders

2

46

Health Care Settings in Marketing

2

47

Activity Reminders

2

48

Educational Reminders for Events

2

49

Appointment of Agents and Licensure

2

50

Reporting of Agents Terminated

2

51

Compensation Rules for Agent/Broker

3

52

Compensation for Agent/Broker

3

53

Training and Testing for Agent/Broker

3

54

Incentives and Rewards

3

55

Check Your Knowledge—Question 4

2

56

Check Your Knowledge—Question 5

2

57

Medicare Advantage and different Medicare Health Plans Resource Guide

7

58

 Part C (MA) Appeals Process

7

59

Acronyms

3

 

Total approximate time in minutes

180