OM
A federal program of health insurance for persons 65 years of age and older
Medicare
Prior to purchasing a Medigap policy, a Beneficiary must be enrolled in ?
A and B
October 15 - December 7
-If individuals submit applications for multiple plans, the application with the latest application date will take effect
-Effective date January 1
AEP
IRMAA stands for?
Income related monthly adjustment amounts
An individual who is eligible for both Medicaid and Medicare is a______?
Medi-Medi Beneficiary or Dual eligible
Hospital stays(mostly)
Skilled nursing facility care
Home health services
Hospice Care
Part A
What Two States Have Guaranteed issue
New York, MASS, Connecticut
Period which an individual is first eligible to enroll in a Part D plan
IEP
A type of cost-sharing where the member pays a flat-dollar amount such as a $5 or $10 ________ each time a covered service is provided.
Co-Payment
MEDI-MEDI
An individual who is eligible for both Medicaid and Medicare
What covers, Doctor visits
Outpatient care(PT, OT, SLP included)
Clinical research
Services that Medicare A does not cover
Services must be medically necessary
Preventive services
DME
Ambulance services
Home health care
X-rays and lab tests
Part B
Oregon, California
This election period Exists for...
-Individuals who are no longer eligible for their current MA plan's coverage due to moving outside of that plan's service area
-Formerly incarcerated individuals who have been released and now reside inside an MA plan's service area
-Individuals moving into an MA plan's service area
SEP
Defined list of medications that includes treatments for all therapeutic categories screened for medical effectiveness, positive results, and value.
Formulary
With Original Medicare , what percent of the charge is the patient responsible for after paying the premium and the deductible?
20%
Who is eligible for Medicare
65+,
Disabled permanently received ss disability for 24 months
Open enrollment for Medigap policies spans a six-month period beginning on the?
First day of the month in which the individual is age 65 or above and enrolls in Part B
- January 1st - March 31st
- current MA/MAPD beneficiaries can
- switch to a different MA/MAPD plan
- drop their MA/MAPD plan and return to OM
- sign up for a PDP plan (if returning to OM)
- new plans become effective the first day of the month following enrollment
- Beneficiaries have ONE shot to do this
OEP
Most plans with Medicare prescription drug coverage (Part D) have a __________ This means that after you and your drug plan have spent a certain amount of money for covered drugs; you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.
Coverage Gap (aka: Donut Hole, Medicare Prescription Drug)
Medigap plans are different in which 3 states?
Minnesota, Mass, Wisconsin
A,B,C,D
The parts of medicare
Medigap plans are designed to?
Pay for some or all of the medical/hospital expenses not covered by Original Medicare
IEP/ICEP
SEP
AEP/OEP
Election Period Hierarchy
_____________ costs, are amounts you pay for covered Part D drugs that count towards your drug plan's out-of-pocket threshold. Your yearly deductible, coinsurance or copayments, and what you pay in the coverage gap all count toward this out-of-pocket limit. The limit doesn't include the drug plan's premium.
True out-of-pocket (TrOOP)
The 4 stages of prescription drugs
Stage 1. Annual Deductible.
Stage 2. Initial Coverage.
Stage 3. Coverage Gap.
Stage 4. Catastrophic Coverage