Section 1: Introduction A. About This Course B. Learning Objectives Section 2: What is a Medicare Advantage Plan? A. Meet Juan! B. What is a Medicare Advantage Plan? C. How Medicare Advantage Plans Work D. Medicare Advantage Costs E. Who Can Join A Medicare Advantage Plan? F. Medicare Advantage (MA) and End-Stage Renal Disease (ESRD) G. When Can You Join or Switch Medicare Advantage Plans? H. Low-Performing Plan I. When You Can Leave Medicare Advantage Plans J. When You Can Leave Medicare Advantage Plans (Cont’d) K. Medicare Advantage Trial Rights and Medigap L. Types of Medicare Advantage Plans M. Medicare Health Maintenance Organization (HMO) Plan N. Medicare Preferred Provider Organization (PPO) Plan O. Medicare Special Needs Plans (SNPs) P. Special Needs Plans (Cont’d) Q. Medicare Private Fee-for-Service (PFFS) Plan R. Medicare Private Fee-for-Service (PFFS) Plan (Cont’d) S. Medicare Private Fee-for-Service (PFFS) Plan Access Requirements T. Medicare and Medical Saving Account Plans U. Medicare Advantage (MA) Plan Network Changes V. Review W. Summary Section 3: Other Medicare Health Plans A. Other Medicare Health Plans B. Medicare Cost Plans C. Innovation Projects and Pilot Programs D. Program of All-Inclusive Care for the Elderly (PACE) Plans E. Review F. Summary Section 4: Rights, Protections, and Appeals A. Guaranteed Rights B. Rights in Medicare Health Plans C. Appeals in Medicare Health Plans D. Medicare Part C Appeals Process E. Rights If You File an Appeal With Your Medicare Health Plan F. Marketing G. Disclosure of Plan Information for New and Renewing Members H. Nominal Gift Reminders I. Unsolicited Beneficiary Contact J. Cross-Selling Prohibition K. Scope of Appointment Reminders L. Marketing in Health Care Settings M. Promotional Activity Reminders N. Educational Event Reminders O. Licensure and Appointment of Agents P. Reporting of Terminated Agents Q. Agent/Broker Information R. Rewards and Incentives S. Review T. Summary Section 5: Conclusion A. Summary B. Acronyms C. Course Contributors D. Resources E. References F. Congratulations
Lisa Hohlbein, RN, CDP brings over 25 years of healthcare experience and offers cutting-edge expertise in the areas of the RAI process and clinical reimbursement systems. Her experience includes performing and overseeing various reimbursement reviews for Medicaid and PPS in multi-state, skilled nursing facilities, long-term care, and sub-acute care assessment and operations. Lisa has presented workshops on a variety of topics at the facility, regional, state, national, and international (Canada) levels. She was a Master Teacher with AANAC, participated on their Expert Advisory Panel, and has presented at their annual conferences. Lisa has also been a contributor to MDS Alert, Provider Magazine, LT Living, and AANAC's LTC Leader. Lisa is also a Certified INTERACT Educator, Certified Dementia Care Practitioner, and was previously a Certified Alzheimer's Disease and Dementia Care Trainer. Disclosure: Lisa Hohlbein, RN, CDP has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.Staff Writer: Adam Roesner, BSN
Adam Roesner, BSN has been working with various quality measures optimization since 2013. His experience in program management in both clinical and performance measures allows a unique perspective on the challenge faced by healthcare systems today. Adam has presented trainings on HCAHPS programs for sales forces and executive leadership alike, and has managed various skin health and HCAHPS educational programs and bundles for acute, post-acute, and IDN facilities. Disclosure: Adam Roesner, BSN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.