Strugglin’ to grasp, understand and easily articulate Medicare’s growing complexity, particularly with Part D? Tryin’ to remember and differentiate the multitudes of acronyms and enrollment periods? Well struggle no more! California Health Advocates’ staff attorney, David Lipschutz has created a simple little ‘Medicare acronym rap’ or ‘mantra’ – which ever style suits you best – whose ‘jingle’ will make everything crystal clear in your mind. Ready?….Excited?….Read below…
An HMO with a PDP is a no-no, a PDP with a PFFS is a go — if the PFFS has no D; if the PFFS has D, then its an MA-PD and you can’t have a PDP. You can enroll in an MSA during the ICEP or AEP, but not the OEP or an SEP; if you want a PDP with an MSA, you can only enroll during the AEP, unless your Part D IEP and Part C ICEP overlap, in which case, have at it. You can’t pick up or change PDPs during the OEP (don’t be ridiculous); if you have an EGHP or VA, forget about an MSA — if you have ESRD and want an MA plan, let’s call the whole thing off.
….Well…hmm…. While this is all factually true, it still does not make sense…. Maybe the intricacies of Medicare are not yet clear…. but the complexity of what we advocates and beneficiaries are all dealing with certainly is!
See the acronym key below for an explanation on this Medicare lingo…
- AEP – Annual Coordinated Enrollment Period – The AEP runs from November 15 through December 31 each year. During this time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1.
- OEP – Open Enrollment Period – The OEP provides beneficiaries with one opportunity to enroll in, disenroll from, or change a Medicare Advantage plan between January 1st through March 31st. Beneficiaries making a change must have Medicare Parts A and B and must live in the MA plan’s service area. Beneficiaries cannot drop Part D coverage or pick up Part D coverage during the OEP.
- SEP – Special Enrollment Period – SEPs allow beneficiaries to make an enrollment change outside of the regular enrollment periods such as the AEP, the OEP and the new Limited Open Enrollment Period (L-OEP). There are SEPs for Part B, C, and D.
- Part B has a SEP for people who didn’t take Medicare Part B when first eligible for Medicare because they or their spouse was working and had health insurance through their employer or union. The last eight months of this Special Enrollment Period starts the month after the employment ends or the group health coverage ends, whichever comes first.
- Parts C and D – A number of SEPs exist for Medicare Advantage and prescription drug plan enrollment and disenrollment. For example, someone who moves out of a Medicare Advantage Plan or PDP service area has an SEP to enroll in a plan that serves their new home. Beneficiaries who move into, reside in, or move out of a nursing home may also have an SEP. Individuals who are eligible for Medicare and Medicaid have an SEP that allows them to change Part D drug plans at any time. CMS has the authority to create SEPs for exceptional circumstances.
- Part D IEP – Initial Enrollment Period – The Part D IEP is the period during which an individual is first eligible to enroll in a Part D plan. It is triggered when someone first gets Medicare Part A or B, and resides in the service area of a Part D plan. The Part D IEP has the same seven-month IEP as Part B — (three months prior to the month of eligibility, the month of eligibility, and three months after). The Centers for Medicare and Medicaid Services (CMS) also now recognizes a new IEP for beneficiaries with disabilities turning 65.
- Part C ICEP – Initial Coverage Election Period – The ICEP is a period during which an individual is first eligible to enroll in an MA plan. It begins three months before the individual’s enrollment in both Part A and Part B and ends on the later of:
- The last day of the month preceding entitlement to both Part A or Part B; or
- The last day of his/her Part B initial enrollment period
- HMO – Health Maintenance Organization – An HMO is a Medicare Advantage plan where a group of doctors, hospitals, and other health care providers provide health care. In an HMO, beneficiaries typically get all their care from the providers who are part of the plan. If they go outside the plan to see a doctor, they may be responsible for the full cost of their care.
- PDPs – Prescription Drug Plans – Plans offered by private companies for Medicare Prescription Drug Coverage. Plans differ in monthly premiums, drugs covered, cost-sharing amounts and participating pharmacies.
- MA-PDs – Medicare Advantage Prescription Drug Plans – Medicare Advantage plans that offer Part D prescription drug coverage.
- PFFS – Private Fee For Service plan – These are MA plans offered by private companies that allow beneficiaries to go to any Medicare-approved doctor or hospital as long as the doctor or hospital accept the terms of the plan’s payment. PFFS plans may or may not offer Part D coverage.
- MSA – Medical Savings Account – are offered by private companies and have two parts:
- A high-deductible Medicare Advantage MSA Health Plan, which covers your Part A and B benefits once you meet the plan’s high yearly deductible; and
- A Medical Savings Account, which is separate bank account into which Medicare deposits money for you. You can use this money to pay for health care costs, including meeting the health plan’s deductible. Any money you do not use will remain in the account and be added to Medicare’s next yearly deposit.MSA plans have no provider network. Yet, like PFFS plans, providers must agree to the plan’s payment. Also, MSAs cannot offer Part D coverage. People in an MSA plan can purchase a separate prescription drug plan (PDP).
- EGHP – Employer Group Health Plan
- VA – Veterans Affairs – often refers to VA health benefits (see http://www1.va.gov/health/)
- ESRD – End Stage Renal Disease – Kidney failure that is severe enough to require lifetime dialysis or a kidney transplant.
