Medicare 101
This federal program primarily serves people age 65 and older, plus certain younger individuals with disabilities.
What is Medicare?
This part of Medicare provides prescription drug coverage.
What is Part D?
The annual period when beneficiaries can switch Medicare Advantage or Part D plans (Oct 15 – Dec 7).
What is the Annual Enrollment Period (AEP)?
This type of SNP is specifically designed for individuals eligible for both Medicare and Medicaid.
What is a D-SNP (Dual Eligible Special Needs Plan)?
The amount you pay monthly for Medicare coverage.
What is a premium?
This part of Medicare covers hospital stays, skilled nursing facilities, and hospice care.
What is Part A?
The coverage gap phase in Part D is commonly known by this nickname.
What is the Donut Hole?
This period (Jan 1 – Mar 31) allows switching between Medicare Advantage plans or returning to Original Medicare.
What is the Medicare Advantage Open Enrollment Period (OEP)?
D-SNP members must maintain eligibility in both programs; losing this coverage may trigger this type of enrollment change.
What is a Special Enrollment Period (SEP)?
The amount you must pay before your coverage begins.
What is a deductible?
This part covers doctor visits, outpatient care, and preventive services.
What is Part B?
The list of drugs covered by a Part D plan is called this.
What is a formulary?
A qualifying life event like moving or losing coverage triggers this type of enrollment period.
What is a Special Enrollment Period (SEP)?
This type of SNP is designed for individuals with specific severe or disabling chronic conditions like diabetes or heart failure.
What is a C-SNP (Chronic Condition Special Needs Plan)?
A fixed amount you pay for a covered service, like a doctor visit.
What is a copayment?
The age most people become eligible for Medicare.
What is 65?
This stage occurs after the deductible but before the coverage gap.
What is the Initial Coverage Stage?
Missing this can result in a late enrollment penalty for Part B or Part D.
What is the Initial Enrollment Period (IEP)?
This requirement ensures D-SNPs coordinate benefits and services between Medicare and Medicaid.
What is state Medicaid coordination (MCO)
The percentage of costs you pay after meeting your deductible.
What is coinsurance?
The enrollment period when someone first becomes eligible for Medicare.
What is the Initial Enrollment Period (IEP)?
Once a beneficiary reaches this phase, they pay significantly reduced costs for drugs.
What is Catastrophic Coverage?
This enrollment period applies to those still working with employer coverage after age 65.
What is the Special Enrollment Period (SEP)?
This is required by a physician for an individual to maintain a Chronic Special Needs Plan.
What is VCC (verify chronic condition)
This type of policy helps cover costs not paid by Original Medicare.
What is Medigap?