Medicare Background
A federal health insurance program that covers those 65 and older, under 65 with certain disabilities and anyone with ESRD or ALS
What is Medicare?
Inpatient hospital, skilled nursing, hospice and home-health care services
What are services covered by Medicare Part A?
Health care option run by the Federal government that combines Part A & B
What is Original Medicare?
A Medicare option that covers everything that Original Medicare covers, plus offers additional benefits
What is Medicare Advantage?
A Medicare option offering predictable copays and deductibles
What is Medicare Advantage?
The office that coordinates with CMS to administer Medicare
What is the Social Security Administration?
Two parts of Medicare most often to have late enrollment penalties
What are Medicare Part B & Part D?
The part of Medicare not included in Original Medicare often included in Medicare Advantage plans.
What is Medicare Part D - Prescription drug coverage?
The parts of Medicare a beneficiary needs to have in order to enroll in a Medicare Advantage plan.
What is Medicare Part A & Part B?
The part of Medicare commonly referred to as "premium-free"
What is Medicare Part A?
The year Medicare was created.
What is 1965?
The phase where members pay a higher % of their drug costs until they reach their TROOP threshold.
What is the "donut hole" or coverage gap?
Prescription drugs, dental services, hearing aids and acupuncture.
What are services not covered by Original Medicare?
The type of Medicare Advantage plan that allows flexibility for in- and out-of-network coverage.
What is a Medicare Advantage PPO plan?
The name of the Quality Bonus Program created by Medicare to rate performance of Medicare Advantage plans.
What is the Medicare Star Rating System?
A Pennsylvania pharmaceutical assistance program
What is PACE?
The 7 month period when most people can enroll in Medicare.
What is the Initial Enrollment Period (IEP)?
The approximate percentage of costs that Original Medicare does not cover.
What is 20%?
Medicare enrollment periods where beneficiaries can change their plan.
What are the AEP, OEP and SEP?
A type of Medicare plan that offers standardized plans throughout the US, regardless of carrier.
What is a Medigap or Supplement plan?
The year the ACA and HCERA (known as Health Insurance Reform Legislation) were implemented.
What is 2010?
The standard Part B premium for 2022
What is $170.10
A limit to the amount of money beneficiaries have to pay out-of-pocket that's not included in Original Medicare.
What is the maximum out-of-pocket (MOOP)?
The type of Medicare Advantage plan that offers lower premiums and cost sharing in exchange for staying in network.
What is a Medicare Advantage HMO plan?
The year the Medicare Modernization Act, which created Part D, began coverage.
What is 1996?
The federal agency that manages Medicare.
What is the Centers of Medicare and Medicaid (CMS)?
The period of time each year, from Oct 15 - Dec 7, when members can change their Medicare plan.
What is the Annual Election Period (AEP)?
A standardized type of Medicare plan that can be purchased along with Original Medicare to cover gaps.
What is a Medigap or Medicare Supplement plan?
During in IEP an individual can enroll/join
What is Medicare Part A, Medicare Part B, Medicare Advantage Plan[if enrolling in Part A and B], Part D [if enrolling in Part A or B] and Medicare Supplement/Gap [enrolled in Part A and B and not enrolled in a Medicare Advantage Plan, MAPD]?
Group plans that may not allow you to return if you leave
What are Federal or company retirement plans?
The Pennsylvania Marketplace Individual coverage for Under 65 website
What is the Pennie?
The length of time during the IEP where you can enroll and not delay coverage.
What is the first 3 months of IEP?
The Medicare option known for providing better quality, more coordinated care than Original Medicare.
What is Medicare Advantage?
The type of Medicare Advantage plan with a higher cost-share for care received out of network.
What is a PPO plan?
Blue Journey and WellSpan HMO and PPO plans.
What types of Advantage plans does Capital Blue Cross offer?