Course Code: REL-PAY-0-EXMAOMP
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2028
Learning Objectives:
Recall the overarching concept, eligibility, and enrollment guidelines for Medicare Advantage and Original Medicare.
Identify the types of Medicare Advantage and other Medicare plans.
Recognize government oversight and regulations of Medicare Advantage, as well as beneficiary rights and protections.
Outline:
Section 1: Overview of Medicare and Medicare Advantage
Evelyn’s Decision
Why Understanding Medicare Is Important
Medicare’s Two Paths: Original Medicare Versus Medicare Advantage
What Is Original Medicare?
What Is Medicare Advantage (MA or Part C)?
A Side-by-Side Comparison
MA Key Updates
MA Eligibility Criteria
What Does It Cost?
Enrollment Windows
What Is Medigap?
Evelyn’s Decision-Making
The Role of Educators and Clinicians
Knowledge Check
Key Takeaways
Section 2: Types of MA and Medicare Plans
Choosing the Right Plan
Evelyn Moves From Costs to Choices
How to Choose the Right Plan
Main Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plan
Special Needs Plans (SNPs)
Medical Savings Account (MSA) Plans
Program of All-Inclusive Care for the Elderly (PACE) Plans
Knowledge Check
Key Takeaways
Section 3: Government Oversight and Regulation
Information Oversight
Evelyn’s Pursuit for Answers
What Counts as Communication Versus Marketing
CMS Review of Materials
Agent and Broker Rules
Protecting Beneficiaries From Unsolicited Contact
Websites and Online Marketing
Educational Versus Marketing Events
Promotional Items and Gifts
Required Disclaimers
Knowledge Check
Key Takeaways
Section 4: Beneficiary Rights and Protections
What Rights and Protections Are There?
Evelyn Faces a New Challenge
Guaranteed Rights for All Beneficiaries
Rights Specific to MA Plans
The MA Appeals Process
Filing Grievances
Knowledge Check
Key Takeaways
Section 5: Conclusion
Course Summary
Course Contributor
Resources
References
Writer: Eric Hutto, DNP
Eric is a graduate of the University of South Florida School of Nursing and has experience in various clinical settings, including critical care and obstetrics. He earned his Doctor of Nursing Practice degree from Georgetown University, where he was recognized as a Pellegrino Student Scholar for his research in clinical bioethics. Eric also completed a fellowship at Duquesne University, which focused on applying genomics in nursing practice. His experiences drive his commitment to improving health outcomes for underserved populations, particularly Black Americans, through advocacy and evidence-based practices.
Target Audience:
The target audience for this course is: Advanced Practice Nurses; Medical Providers; Nursing Personnel; in the following settings: Ambulatory Care, Clinics: Primary Care, Clinics: Rural Health, Hospitals: Acute, Hospitals: Critical Access (CAHs).
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, 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.
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.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.