Medicare Advantage and Other Medicare Plans Resource

Medicare Advantage and Other Medicare Plans Resource 

Welcome to the Medicare Advantage and Other Medicare Health Plans learning module, presented by Relias! The lessons in this module explain Medicare health plan options other than the original Medicare. This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Federally-facilitated Health Insurance Marketplace.


Hours: 2.50


Certificates provided by accrediting body (0 Match)

Course Details

Course Code: REL-PI-0-P40
Hours: 2.5
Type: Online Course
Content Expiration Date: 2/28/2022
Learning Objectives:
1. Define Medicare Advantage (MA) Plans
2. Describe how MA Plans work
3. Explain eligibility requirements and enrollment
4. Recognize types of MA Plans
5. Identify other Medicare health plans
6. Recall rights, protections, and appeals
7. Summarize the Medicare Marketing Guidelines

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

Expert Reviewer: Lisa Hohlbein, RN, CDP
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.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.