Annual Enrollment period (AEP) - ANSWER-The AEP occurs October 15 through December 7
each year. During this time, all Medicare eligible beneficiaries can enroll in, disenrollment from
or change MA,, MA-PD or PDP plans. coverage changes made during the AEP are effective
January 1 of the following year. If Medicare eligible beneficiaries do not make a change, their
current coverage continues into the next year with any applicable premium or benefit design
adjustments.
Appeal - ANSWER-A Special kind of complaint members make if they disagree with certain kinds
of decisions made by Medicare or their health of prescription drug plan. they can appeal if they
request coverage for health care service care service, supply or prescription that they think they
should be able to get or request payment for health care already received, and medicare or a
plan denies the request, that can also appeal if they are already receiving coverage and the plan
stops paying. there are specific processes that both the member and the plan must use for
appeals.
Application Date - ANSWER-The Application date is the date the enrollment request is received
by the plan. this Includes the date it is received by a sales person.
Beneficiary - ANSWER-The name for the person who has health care insurance through the
Medicare of medical programe
Benefit period - ANSWER-For Original Medicare, the benefit period begins on the first day of a
hospital stay and ends when you have out of the hospital or skilled nursing facility for 60 days in
a row. If you go into the hospital after one benefit period has ended a new benefit period
begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit
to the number of benefit periods you can have.
Catastrophic coverage - ANSWER-Coverage that applies when a member has very high drug
costs. for all Medicare prescription drug plans. it begins after a member has paid. $4,550 in
, 2014 out-of-pocket for covered drugs in a calendar year. Once this out-of-pocket level is reached
the member pays the greater of 5 % of the cost for each coverd prescription of a small copy
untill the end of the calendar year.
Centers for Medicare & Medicaid Services - ANSWER-The federal agency that runs Medicare and
works with each state to run their medicare programe.
Coinsurance - ANSWER-The percentage of the Medicare-approved amount you pay for a
medical service. With some plans you do not pay coinsurance until you have paid a deductible,
Copayment (copay) - ANSWER-A fixed amount you pay for each medical service, such as a
doctor's visit. For example a copayment might be $20 for a doctor's visit and $7 for a
prescription drug you receive.
Cost sharing - ANSWER-The way medicine and your health plans share you health care costs
with you. Types of cost sharing you may pay include deductibles, coinsurance and copayments.
Coverage gap - ANSWER-This stage of prescription drug coverage is often referred to as the
donut hole. Once a member's total yearly covered prescription drug costs %2,850 in 2014, the
member reaches the coverage gap and pays 72% of the plans costs for generic drug and no
more than 47.5% of the plans costs for brand-name drugs until total out of pocket drug costs
reached %4,550 (in 2014)
Creditable Prescription Drug Coverage - ANSWER-Creditable prescription drug coverage is drug
coverage that pays, on average at least as much as Medicare standard prescription drug benefit
beneficiaries who have prescription drug coverage as part of health plan. such as veteran
administration drug benefits. through an employer group or union plan. Member currently has
prescription he or she may keep that coverage and wait to enroll in a part d plan.If they decide
to enroll in a part D plan later. they will not have to pay a late enrollment penalty. examples of
coverage that likely include creditable prescription drug covarge are assistance Program.
Because the standard part d benefits change each year. it is important for beneficiaries to verify
each year. During this time, all Medicare eligible beneficiaries can enroll in, disenrollment from
or change MA,, MA-PD or PDP plans. coverage changes made during the AEP are effective
January 1 of the following year. If Medicare eligible beneficiaries do not make a change, their
current coverage continues into the next year with any applicable premium or benefit design
adjustments.
Appeal - ANSWER-A Special kind of complaint members make if they disagree with certain kinds
of decisions made by Medicare or their health of prescription drug plan. they can appeal if they
request coverage for health care service care service, supply or prescription that they think they
should be able to get or request payment for health care already received, and medicare or a
plan denies the request, that can also appeal if they are already receiving coverage and the plan
stops paying. there are specific processes that both the member and the plan must use for
appeals.
Application Date - ANSWER-The Application date is the date the enrollment request is received
by the plan. this Includes the date it is received by a sales person.
Beneficiary - ANSWER-The name for the person who has health care insurance through the
Medicare of medical programe
Benefit period - ANSWER-For Original Medicare, the benefit period begins on the first day of a
hospital stay and ends when you have out of the hospital or skilled nursing facility for 60 days in
a row. If you go into the hospital after one benefit period has ended a new benefit period
begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit
to the number of benefit periods you can have.
Catastrophic coverage - ANSWER-Coverage that applies when a member has very high drug
costs. for all Medicare prescription drug plans. it begins after a member has paid. $4,550 in
, 2014 out-of-pocket for covered drugs in a calendar year. Once this out-of-pocket level is reached
the member pays the greater of 5 % of the cost for each coverd prescription of a small copy
untill the end of the calendar year.
Centers for Medicare & Medicaid Services - ANSWER-The federal agency that runs Medicare and
works with each state to run their medicare programe.
Coinsurance - ANSWER-The percentage of the Medicare-approved amount you pay for a
medical service. With some plans you do not pay coinsurance until you have paid a deductible,
Copayment (copay) - ANSWER-A fixed amount you pay for each medical service, such as a
doctor's visit. For example a copayment might be $20 for a doctor's visit and $7 for a
prescription drug you receive.
Cost sharing - ANSWER-The way medicine and your health plans share you health care costs
with you. Types of cost sharing you may pay include deductibles, coinsurance and copayments.
Coverage gap - ANSWER-This stage of prescription drug coverage is often referred to as the
donut hole. Once a member's total yearly covered prescription drug costs %2,850 in 2014, the
member reaches the coverage gap and pays 72% of the plans costs for generic drug and no
more than 47.5% of the plans costs for brand-name drugs until total out of pocket drug costs
reached %4,550 (in 2014)
Creditable Prescription Drug Coverage - ANSWER-Creditable prescription drug coverage is drug
coverage that pays, on average at least as much as Medicare standard prescription drug benefit
beneficiaries who have prescription drug coverage as part of health plan. such as veteran
administration drug benefits. through an employer group or union plan. Member currently has
prescription he or she may keep that coverage and wait to enroll in a part d plan.If they decide
to enroll in a part D plan later. they will not have to pay a late enrollment penalty. examples of
coverage that likely include creditable prescription drug covarge are assistance Program.
Because the standard part d benefits change each year. it is important for beneficiaries to verify
