Annual Election Period (AEP)

Annual Election Period allows Medicare beneficiaries to review their current plan each year, in order to choose HOW they will receive their Medicare benefits for the upcoming year. Runs from Oct. 15 through Dec. 7 each year.

Cost Sharing

Out-of-pocket expenses you pay in your insurance plan, often including deductibles, co-payments, and co-insurance.

Co-Insurance

The percentage of your medical bill that you owe after your deductible has been paid.

Co-Pays

The amount of money you pay out of pocket at each doctor’s visit.

Deductibles

The annual amount you must pay toward medical bills before insurance kicks in.

Initial Enrollment Period (IEP)

The Initial Enrollment Period is the timeframe you are able to sign up for Part A and/or Part B. The timeframe includes the month you are turning 65, plus the three months before and the three months after (a total of seven months).

Low Income Subsidy (LIS)

Also known as “Extra Help,” those eligible receive assistance with Part D, prescription drugs.

Maximum Out-Of-Pocket (MOOP) Limit

The maximum amount of money you will have to pay in a year in deductibles, co-payments, and co-insurance. Once this limit is reached, insurance will pay for all expenses included in your coverage.

Medicare Advantage (MA) and
Medicare Advantage and Part D (MAPD) 

Also known as Medicare Part C, MA/MAPD is a health plan option that is part of the Medicare program.  A way of covering all the Original Medicare benefits through private health insurance companies. There are extra benefits and lower copayments than Original Medicare Plan.

Open Enrollment Period (OEP)

Open Enrollment Period is for anyone currently on a MAPD plan who wants to switch MAPD plans, return to original Medicare, or switch to a supplement and drug plan. Runs from Jan. 1 through Mar. 31 each year. 

Original Medicare

Includes Part A and Part B and is federally managed.

Part A

Hospital Insurance (Original Medicare)

Part B

Medical Insurance (Original Medicare) 

Part C

Medicare Advantage Plans; private carriers who manage Part A and Part B

Part D (also known as PDP)

This is a stand-alone drug plan for prescription drug coverage (understanding formularies & tiers).

Prescription Drug Plan (PDP)
also known as Part D

Use of network of pharmacies within a service area. Enrollees are eligible 7 months surrounding their Medicare effective date. They must be entitled to Part A or enrolled in Part B and reside in the plan's service area.  Enrollees can expect a monthly premium, an annual deductible, and per prescription cost-sharing: using formularies and tiers. PDPs are typically purchased with Medicare Supplement plans, which do not include a drug plan.  PDPs cannot be purchased with a Medicare Advantage plan, which already includes a drug plan.

Premiums

The monthly amount you pay to an insurance company for coverage. 

Star Ratings

Medicare Advantage Plans and Part D plans are rated in multiple categories using a five-star system, with one being the lowest and five being the highest.

Supplement Plans (MedSup) 

Medicare supplement insurance plans, like Medigap, helps cover costs like co-payments, deductibles, and co-insurance. Benefits vary from plan to plan; Plan A to Plan N. Medicare Supplements do not include a drug plan. Prescription Drug Plan (PDP) must be purchased separately.

Special Enrollment Period (SEP)

Special Enrollment Periods are only offered for special circumstances. During this period, qualified individuals can can join, switch, or drop plans.

Special Needs Plan (SNP)

A Medicare Advantage Plan for people with chronic illness, people who are dual eligible, or people who are institutionalized.