How Do You Become a Certified Medicare Specialist?

A certified medicare specialist has a deep understanding of the Medicare program, helping patients and providers navigate the government-funded healthcare system. They can work in a variety of jobs and build their knowledge and experience through professional education and training.

Become a Medicare Consultant

If you’re interested in a career as a certified medicare specialist, the first step is to become licensed to sell health insurance products in your home state. You can learn to do this online or by taking an in-person course. Then, you’ll need to pass a state insurance exam to become certified.

Once you’ve completed your training, you can start selling Medicare and other health plans to your clients. You’ll need to recertify with each carrier every year, so make sure you’re keeping up with all of your certifications and trainings.

AHIP Training

The Center for Medicare and Medicaid Services (CMS) requires all health insurance agents to take a course through America’s Health Insurance Plans (AHIP). You can learn about the basics of Medicare, fraud, waste and abuse, marketing compliance and other ethical issues. You’ll also receive training on how to properly enroll and market Medicare and other health products.

You’ll need to complete two courses and take an exam to obtain your AHIP certification. This is a great way to learn about the Medicare program, which will help you earn policyholders’ trust.

Join Communities of Other Agents

You can find other Medicare agents through an insurance community or online social networking sites like LinkedIn or Facebook. These groups are a great place to ask questions, share tips and connect with other professionals in the field.

Get a Medicare License and FMO Contracts

To begin selling Medicare, you’ll need to get your license and complete a contract with a field marketing organization (FMO). These companies distribute health-insurance plans from multiple insurers. The company will pay you a commission if you meet sales goals, and they may offer other support resources as well.

AHIP Training and Certification

You’ll need to attend an AHIP training and certification workshop every year. This includes information on the basics of the Medicare program, including eligibility and benefits, as well as training on Medicare Advantage and Part D prescription drug plans. You’ll also learn about deductibles, coinsurance costs and claims adjudication.

Life and Health CE

After obtaining your Medicare license and working with an FMO, you can begin completing your continuing education (CE). You’ll need to complete several health and life CEs during the year. Many of these courses are free, and many health insurance vendors will also offer these classes for you as part of your AHIP training.

RAC-CTA Advanced Certification

If you have at least one year of consulting experience with the RAI process, MDS 3.0 and Medicare billing, consider enrolling in AAPACN’s Resident Assessment Coordinator – Certified Advanced (RAC-CTA) education and certification. The RAC-CTA is an industry-recognized credential that demonstrates your skill and expertise in the field of clinical reimbursement, Medicare program compliance and integrity, RAI/MDS program integrity, leadership, ethics and medical review.