Glossary of Medicare Terms
AEP (Annual Election Period)
October 15th – December 7th. The period of time when you can change your Medicare Health Plan or prescription coverage for the following year.
ANOC: Annual Notice of Change (ANOC)
Annual Notice of Change is the yearly document your insurance company will send notifying you of any changes that may occur to your plan in the next year. Generally, it will include information about changes in costs, coverage or service area.
What is ANOC and Why Is It Important?
Annual renewable
Guaranteed benefits for a certain period (usually 1 year).
Coinsurance
An amount you may be required to pay as your share of the cost of services after the deductible. It is usually a percentage.
Co-pay
The amount you pay for a medical service. It is usually a set amount.
Deductible
The amount you pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
DME (Durable Medical Equipment)
Medical equipment ordered by your doctor to use at home. Examples… Walker, Cane, CPAP Machine, etc.
Donut Hole
The coverage gap that is inherent in most Medicare PDP plans. This is a temporary limit on what the plan will cover, and it begins after you have reached a specified limit for spending on covered drugs.
The Medicare Donut Hole: How Does It Work?
Extra Help:
Is a low income subsidy for prescription drug costs. Under this program, beneficiaries get assistance in paying for their Part D monthly premium, annual deductible, coinsurance and copays.
What is Low Income Subsidy for Medicare Prescription Drug Coverage?
Formulary
List of prescription medications covered by your insurance plan
Formulary Exception
A request for coverage for a non-formulary medication.
Guaranteed renewable
Guaranteed benefits if the premium is paid. Benefits remain the same – the premiums can change.
Max out of pocket
The amount you will pay before your Medicare plan pays 100% of covered health expenses.
Medicare Beneficiary
Individual who is entitled to benefits under Medicare Part A and/or Part B.
PDP
a prescription drug plan (PDP) is obtained from a private insurance company that has a contract with Medicare and provides coverage for prescriptions medications that are filled at pharmacies in retail and health care facilities.
Medicare Part D
Premium
The amount you pay an insurance company – typically once per month or once per year – in exchange for your insurance policy coverage.
Scope of Appointment (SOA)
A CMS requirement of written or verbal consent to discuss health care related (Medicare) products during an appointment.
Usual, Customary and Reasonable Fees (UCR)
The typical amount charged and paid for medical care in a geographical area based on what providers usually charge for the same or similar medical service.
