Annual Election Period (AEP) – From Oct. 15 through Dec. 7, people who are Medicare-eligible can enroll in, disenroll from, or change to the Medicare Advantage Plan or Medicare Prescription Drug Plan of their choice for the following year.
Coinsurance – A percentage of your medical and drug costs that you pay out of pocket.
Copayment – The fixed dollar amount you pay when you receive medical services or have a prescription filled.
Creditable Coverage – Health coverage you had in the past that gives you certain rights when you apply for new coverage.
Deductible – The amount you pay for medical services or prescriptions before your plan pays for your benefits.
Formulary – Also called a “drug list,” the formulary lists the drugs your plan covers. It’s often divided into sections – or “tiers” – based on the amount your plan will pay for the drugs in that group.
Health Maintenance Organization (HMO) – generally, a primary care physician arranges your healthcare within the plan’s network.
Initial Enrollment Period (IEP) – When you’re eligible to sign up for Part A and/or Part B for the first time.
Mail-Order Pharmacy – order through a mail-order pharmacy and have your maintenance or specialty medicines and diabetic supplies delivered to your home. Using a mail-order pharmacy may help you stay on track with your doctor’s orders since you’ll receive up to a 90-day supply and regular reminders when it’s time to refill.
Medically Necessary – Medicare defines this as services or supplies needed for the diagnosis or treatment of a medical condition. These services and supplies must meet the standards of good medical practice in the local area and can’t be mainly for the convenience of you or your doctor.
Network – A group of healthcare providers that has agreed to provide care based on a plan’s terms and conditions. These providers include doctors, hospitals, and other healthcare professionals and facilities.
Out-Of-Pocket Costs – Anything you pay out of your pocket for medical care, prescriptions, and other healthcare services. These include coinsurance, copayments, and deductibles
Original Medicare – Original Medicare is the traditional fee-for-service program offered directly by the federal government and the federal government pays directly for your healthcare. You can see any doctor who takes Medicare anywhere in the country.
Preferred Provider Organization (PPO) – This type of health plan gives you freedom to choose your own doctors and hospitals. However, your out-of-pocket costs are usually lower if you choose healthcare providers in the plan’s network.
Premium – What you pay Medicare or a health plan for healthcare coverage.
Private-Fee-For-Service Plan (PFFS) – Requires the member to find doctors, hospitals, and other types of providers that accept the plan’s payment terms. Some PFFS plans have a network of providers; you can still see out-of-network providers that accept the plan’s payment terms, but you may pay more.
Special Enrollment Period (SEP) – If you are age 65 or older, you or your spouse are still working and you are covered under a group health plan based on that current employment, you may not need to apply for Medicare medical insurance (Part B) at age 65. You may qualify for a “Special Enrollment Period” (SEP) that will let you sign up for Part B:
During any month you remain covered under the group health plan and your, or your spouse’s, current employment continues; or
In the eight-month period that begins with the month after your group health plan coverage or the current employment it is based on ends, whichever comes first.
Special Needs Plan (SNP) – Plans that offer benefits, providers, and drug lists designed to meet the specific needs of the groups they serve. People with chronic conditions –like diabetes or heart conditions – or are dually eligible for Medicare and Medicaid, often have this type of plan.
