Medicare 101

An Online Course from the American Health Law Association

As the nation's largest payer, Medicare has an unparalleled impact on how health care is provided and paid for in the United States, affecting not only Medicare beneficiaries, but ultimately also the individuals covered by commercial insurance and other payers.

Changes in Medicare rules impact how and where health care is delivered—and who delivers it. Given the importance of Medicare participation to the financial viability of most U.S. health care enterprises, understanding how Medicare operates is a prerequisite for all health law professionals.

This self-paced online course features short interactive lessons, videos, and knowledge checks to keep learners engaged. Review the full course syllabus below.

Course Details: This interactive online course will take approximately six hours to complete. CLE and CCB available/pending in states where self-study is permitted. Discounted licenses are available to groups of ten or more. For information, email [email protected].

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Course Syllabus and Faculty

Faculty Chair: Daniel J. "Dan" Hettich

King & Spalding LLP

Module 1: Introduction to Medicare

This module provides a high-level description of the Medicare program and how it works, with an emphasis on scope and importance.

Faculty: Jeanne L. Vance, Weintraub Tobin Chediak Coleman Grodin Law Corp.

20 minutes

Module 2: Medicare Part A

This module addresses Part A coverage, reimbursement through the prospective payment system, the beneficiary's out-of-pocket costs, how the Part A program is administered throughout the country, and how Part A interacts with Medicare Parts B and C.

Faculty: Emily J. Cook, McDermott Will & Schulte

35 minutes

Module 3: Medicare Part B

This module discusses services and other benefits covered under Part B, payment to general acute care hospitals (subsection (d) hospitals), outpatient services that are treated as inpatient services, and the Medicare physician fee schedule.

Faculty: Regan E. Tankersley, Hall, Render, Killian, Heath & Lyman, PC

25 minutes

Module 4: Medicare Part C

This module talks about the different types of Medicare Advantage plans, provides an overview of Part C benefits, and explains the annual bidding process and reimbursement methodology. Module 4 also addresses the beneficiary's enrollment and disenrollment process, as well as appeal/grievance options.

Faculty: Elizabeth B. Lippincott, Strategic Health Law

45 minutes

Module 5: Medicare Part D

This module covers Medicare Part D, the optional private prescription drug insurance plan available to Medicare enrollees. The lessons explain Part D eligibility and enrollment, Part D plan types, resources for low-income beneficiaries, the "three phases" of Part D benefit design, formulary development, the role of pharmacies, and how components of Part D have been shaped by courts' interpretation of the Social Security Act.

Faculty: Ross Margulies and Shannon Gonick, Manatt, Phelps & Phillips, LLP

50 minutes

Module 6: Medicare's Impact on Health Care Access and Quality

This module provides a brief history about how Medicare came to be and how a Fourth Circuit case and the passage of major laws extended the anti-discrimination prohibition to health care providers. The lessons in this module also address EMTALA and how Medicare works to ensure not only access, but access to high quality care through a variety of programs.

Faculty: Felicia Sze and Rawan Khalili, Athene Law LLP

35 minutes

Module 7: Medicare's Impact on Health Care Costs

This module addresses Medicare's impact on health care costs, the program's efforts to contain costs while continuing to provide high quality care, more recent changes to control cost through the 2025 One Big Beautiful Bill Act, and ongoing efforts to balance access, quality, and cost.

Faculty: Alexandra B. "Allie" Shalom and Lauren P. Carboni, Foley & Lardner LLP

45 minutes

Module 8: Medicare Fraud

This module discusses the major federal laws and statutes that are used to prosecute Medicare fraud: the federal Civil False Claims Act, the federal Overpayment Statute, Anti-Kickback Statute, Civil Monetary Penalty Laws, Beneficiary Inducement Law, Physician Self-Referral Law, and Criminal Fraud Statutes.

Faculty: Susan Banks, Holland & Knight LLP

55 minutes

Module 9: Appeals and Arbitration: Resolving Medicare Disputes

This module focuses on the appeals and dispute process available to health care providers when they want to dispute a final determination of Medicare reimbursement. The lessons in this module also address the role of CMS's Department Appeals Board, Part C arbitration, the 340B program, and Chevron Deference and the new Loper standard.

Faculty: Daniel J. "Dan" Hettich, King & Spalding LLP

45 minutes

Module 10: The Future of Medicare

This module discusses demographic trends, trends in enrollment, other changing factors, and what all of this might suggest for Medicare's long-term solvency.

Faculty: Katrina A. Pagonis and Martha P. Cramer, Hooper, Lundy & Bookman, PC

20 minutes