Senior Insurance Acronyms for New Medicare Beneficiaries. It seems there is an entirely different language for the Medicare program. For those of you who need a little help in understanding what in the heck everyone is talking about, here's a little cheat sheet to help.
Medicare – A health program run by the Federal government for those over 65 or with certain conditions
Medicaid – A health program FUNDED by the federal government but ADMINISTERED by individual states
MA– Medicare Advantage Plan
MAPD – Medicare Advantage Plan with Prescription Drug Coverage
PDP – Prescription Drug Plan: Typically sold with Medicare Supplements or certain types of MA only plans
SOA – Scope of Appointment form: Permission slip to talk to beneficiaries about specific benefits of MA plans. The Scope should be signed by the beneficiary prior to talking about benefits.
HMO – Health Maintenance Organization: Type of Health plan. Must use plan doctors for covered services. Members are assigned a PCP or Primary Care Physician, and most require referrals to see Specialists (dermatologists, cardiologists, etc.)
PPO – Preferred Provider Organization: Type of Health plan. Members can go in and out of network for care. Going to in-network providers generally results in lower costs.
PFFS – Private Fee for Service: Type of Medicare Advantage Health plan. These plans allow you to see any Medicare approved provider as long as the provider agrees to the plan’s payments, terms and conditions. Most PFFS plans cover prescriptions, some do not. PFFS MA-only plans (no Rx) are the only MA plan that allows you to purchase a separate stand-alone Part D PDP plan.
SNP – Special Needs Plan: Medicare Health plans for people with special needs. There are 3 different kinds of SNP’s; I-SNP, D-SNP, and C-SNP.
C-SNP – Chronic Special Needs Plan: Designed for people with chronic health conditions such as Diabetes, COPD or Chronic Heart Failure
D-SNP – Dual Special Needs Plan: Designed for people with Medicare and Medicaid.
I-SNP – Institutional Special Needs Plan: plan for beneficiaries needing treatment from Long-term Care or Skilled Nursing for more than 90 consecutive days.
Medicare Supplement/Medigap policy– Plan offered by private companies for an additional premium. Plans A through N are offered. These plans are standardized by letter and offer the same benefits regardless of carrier. A Plan G from Aetna has the same benefits as a Plan G from Cigna or any other carrier.
FPL – Federal Poverty level: U.S. Federal Poverty Guidelines used to determine financial eligibility for certain Federal and State programs Such as Medicaid, LIS and MSP’s.
LIS – Low Income Subsidy: Federal program to help with Rx costs. Available to those making up to 150% of the Federal Poverty Level (FPL) to qualify.
MSP – Medicare Savings Program: Federal program designed to help with premiums, co-pays, and co-insurance. Different levels of help are: QMB, SLMB, QI-1. Income levels up to 135% of the FPL qualify.
IEP – Initial Enrollment Period: 3 months before, the month of, and 3 months after your 65th birthday. Can enroll in any Medicare Health Plan during this time.
AEP – Annual Enrollment Period: October 1st to December 7th, period when Medicare beneficiaries can change their type of coverage or enroll in a MA/MAPD or a PDP.
MA-OEP – Medicare Advantage Open Enrollment Period. You must be enrolled in a Medicare Advantage plan to take advantage of the MA-OEP. You have a one-time opportunity to change Medicare Advantage plans during the first 3 months of the year. You can also disenroll from your Medicare Advantage plan and enroll in original Medicare Parts A and B with or without a Medicare Part D plan. If you can pass underwriting, you can also enroll in a Supplement plan at this time. Also available to those who enrolled in a Medicare advantage plan during their IEP.
SEP – Special Enrollment Period: period that you can enroll in an MA/PDP plan outside of AEP
OEP for Medicare Supplements – Open Enrollment Period for Medicare Supplement: The 6 months after a Medicare beneficiary is enrolled in Medicare Part B and is 65 or older. This cannot be extended or repeated.
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