Get to know the complex world of health care in a way that makes sense to you. A basic understanding of these key words will make it easier for you to navigate your health plan:
Annual Enrollment Period (AEP) is Medicare's Annual Enrollment Period (AEP). This is usually October 15 through December 7 each year. Elections made during the Annual Enrollment Period take effect January 1 of the following year.
Claim is a request for payment you or your doctor sends to your health insurance company when you receive medically necessary services you want covered.
Copay is the fixed amount you pay every time you receive health care services.
Coinsurance is your share of the costs of a covered health care service.
Deductible is the amount you owe for health care services before your health insurance kicks in.
Extra Help is a Medicare program to help people with limited incomes. People may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call toll-free 1-800-MEDICARE (1-800-633-4227), 7 days a week, 24 hours per day, local time. TTY users should call toll-free 1-877-486-2048.
Health Maintenance Organization (HMO) is a managed care plan.
Initial Enrollment Period (IEP) is the period during which an individual is first eligible to enroll in a Medicare plan. Individuals who are becoming eligible for Medicare will have an Initial Enrollment Period that is the seven (7) month period surrounding Medicare eligibility (same as the IEP for Part B). That is, the initial enrollment period is the three (3) months before becoming eligible for Medicare, the month of eligibility, and the three (3) months following eligibility. Individuals first eligible for Medicare based on disability, who subsequently lose Medicare entitlement, have another Initial Enrollment Period. Individuals first eligible for Medicare based on disability who do not have a lapse in Medicare entitlement prior to their turning 65 do not have an additional Initial Enrollment Period. If you believe you are entitled to a plan as a result of an IEP, please feel free to contact us to discuss it and/or you may call the Customer Service department.
Medicare Advantage Disenrollment Period (MADP) is January 1 through February 14. Anyone enrolled in a Medicare Advantage Plan has an opportunity to leave that plan and return to Original Medicare. Also during January 1 through February 14, you can add drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan.
Network refers to a group of doctors, specialists, urgent cares and hospitals your health insurance company has partnered with to help save you money.
Out-of-pocket maximum is the most you’ll pay for covered benefits in any one year.
Point-of-Service (POS) plans combine elements of both a health maintenance organization (HMO) and a preferred provider organization (PPO) plan.
Primary care provider (PCP) is the doctor you see first for common health concerns and continuing care.
Referral is a recommendation from your primary care provider (PCP) to receive services or care from another doctor or facility. Your PCP may refer you through an online provider center referral form or by completing a hard copy referral form.
Special Election Period (SEP) is when an individual may change health plans or return to Original Medicare.
Specialist is a provider or doctor who has advanced education and clinical training in a specific area of medicine.