CMS Training - Understanding Medicare

CMS Training - Understanding Medicare 

This is the CMS Understanding Medicare training module brought to you by Relias Learning. “Understanding Medicare” provides an overview of the Medicare program. It also gives a brief introduction to Medicaid, the Children’s Health Insurance Program (CHIP), the Federally-facilitated Health Insurance Marketplace, and key resources for these programs. 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. To check for an updated version, visit The CMS National Training Program provides this as an informational resource for our partners. It’s not a legal document or intended for press purposes. The press can contact the CMS Press Office at [email protected] Official Medicare program legal guidance is contained in the relevant statutes, regulations, and rulings.


Hours: 4.00


Certificates provided by accrediting body (0 Match)

Course Details

Course Code: REL-PI-0-P41
Hours: 4
Type: Online Course
Content Expiration Date: 3/31/2022
Learning Objectives:
Summarize the Medicare program
Compare the parts of Medicare and coverage options
Describe Medicare-covered services and supplies
Recognize Medicare rights and appeals
Explain programs for people with limited income and resources

Section 1: Introduction A. About This Course B. Learning Objectives Section 2: Program Basics A. Meet Phil B. What is Medicare? C. The 4 Parts of Medicare D. Automatic Enrollment E. Medicare Card F. When Enrolling Isn’t Automatic G. When to Enroll in Medicare H. General Enrollment Period (GEP) I. Premium Part A and Part B Special Enrollment Period (SEP) J. When Employer or Union Coverage Ends K. Original Medicare Part A-Hospital Insurance Coverage L. Paying for Medicare Part A M. Inpatient Hospital Care N. Benefit Periods O. Paying for Inpatient Hospital Stays P. Skilled Nursing Facility Covered Services Q. Skilled Nursing Facility (SNF) Care-Required Conditions for Coverage R. Paying for Skilled Nursing Facility Care S. 5 Required Conditions for Home Health Care Coverage T. Paying for Home Health U. Part A Hospice Care V. Covered Hospice Services W. Paying for Hospice Care X. Medicare Part B-Medical Insurance Coverage Y. What Are Medicare Part B Covered Services Z. Review AA. Summary Section 3: Preventative Services A. Paying for Preventative Services B. NOT Covered by Part A and Part B C. Medicare Part B Costs for Most People D. What You Pay-Part B Premium E. What You Pay-2016 Standard Part B Premium F. Paying the Part B Premium G. Part B Late Enrollment Penalty H. Part B Late Enrollment Penalty Example I. When You Must Have Part B J. Review K. Summary Section 4- Your Medicare Coverage Choices A. Medicare Coverage Choices B. Original Medicare C. Assignment D. Don’t Accept/Must Accept Assignment E. Private Contracts F. Medicare Supplement Insurance (Medigap) Policies G. Medigap Plans H. Medigap Policies I. Delayed Medigap Open Enrollment Period (OEP) J. Pre-Existing Conditions and Medigap K. Medigap for People With a Disability or End-Stage Renal Disease (ESRD) L. Review M. Summary Section 5- Medicare Prescription Drug Coverage A. What’s Medicare Prescription Drug Coverage (Part D)? B. Medicare Part D Drug Coverage C. Medicare Part D Costs D. Standard Structure E. Part D Eligibility Requirements F. Part D Initial Enrollment G. When You Can Join or Switch Plans H. Special Enrollment Period (SEP) I. 5-Star Special Enrollment Period (SEP) J. Part D Late Enrollment Penalty K. Income-Related Monthly Adjustment Amount (IRMAA) L. Part D Covered Drugs M. Required Coverage N. Requirements for Prescribers O. Drugs Excluded by Law Under Part D P. How Plans Manage Access to Drugs Q. Formulary R. Review S. Summary Section 6- Medicare Advantage (MA) Plans (Part C) A. What’s a Medicare Advantage Plan? B. How Medicare Advantage Plans Work C. Medicare Advantage Costs D. Who Can Join a Medicare Advantage Plan? E. When You Can Join or Switch Medicare Advantage (MA) Plans F. When You Can Leave Medicare Advantage (MA) Plans G. Types of Medicare Advantage Plans H. Other Medicare Plans I. Compare Plans on Medicare Plan Finder J. Review K. Summary Session 7- Rights and the Appeals Process A. Medicare Guaranteed Rights B. Your Medicare Rights C. “Notice of Privacy Practices for Original Medicare” D. Who’s the Medicare Beneficiary Ombudsman? E. Medicare Rights-Claims and Appeals F. Medicare Grievance Rights G. Medigap Rights in Original Medicare H. Coverage and Appeal Rights in Medicare Health Plans I. Requesting Part D Appeals J. Review K. Summary Section 8- Programs for People with Limited Income and Resources A. What Is Medicaid and the Children’s Health Insurance Program (CHIP)? B. Medicare Savings Programs C. What Is Extra Help? D. Qualifying for Extra Help E. Steps to Take F. Programs in U.S. Territories G. Review H. Summary Section 9- Medicare and the Health Insurance Marketplace A. Marketplace and People with Medicare B. Marketplace and Becoming Eligible for Medicare C. If You Have a Marketplace Plan First and Then Get Medicare Coverage D. Choosing Marketplace Instead of Medicare E. Medicare for People with Disabilities and the Marketplace F. Marketplace/Medicare Enrollment Considerations G. Review H. Summary Section 9- Conclusion A. Summary B. Course Contributor C. Resources D. Original Module and Supplementary Materials E. References F. Congratulations! G. Exam H. Brain Sparks

Instructor: Centers for Medicare & Medicaid Services National Training Program
The core components of this training module were developed and approved by the Centers for Medicare & Medicaid Services National Training Program (NTP). The original CMS content was enhanced with the addition of interactive vignettes, brought to you by Relias Learning. Disclosure: Centers for Medicare & Medicaid Services National Training Program has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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