Medicare Advantage

What’s in a Name? Medicare Acronyms You Should Know

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Technically, an “acronym” is a set of letters that spell out a word that’s pronounced as a single name, like NASA or radar (which, fun fact, stands for radio detection and ranging). But because common usage translates acronym to mean any set of letters that stand for something else, we’re going to use acronym to mean just that. And when it comes to Medicare, there are plenty of acronyms (or initials) to keep up with. In short, the government tends to speak in code, and learning that code can help you decipher the health plans available to you as you get older.

There’s lots to learn when you’re nearing Medicare eligibility, not the least of which is the acronyms that represent things like coverage and enrollment. Riddled with sets of initials, Medicare and Medicare Advantage can feel like wading through alphabet soup sometimes. We won’t cover every acronym here, but we wanted to give you an overview of the common Medicare initials and what they mean so you can navigate your options with confidence.

 

Acronym What It Means
Basic
CMS The federal agency that administers the Medicare program is the Centers for Medicare & Medicaid Services (CMS). This government organization is part of the Department of Health and Human Services. Social Security is responsible for enrollment into Medicare, but the CMS handles policy changes, regulations and other aspects of the program on an administrative basis.
FFS Also known as traditional or original Medicare, fee-for-service (FFS) Medicare comprises Part A and Part B coverage. It’s administered by the government. Traditional Medicare includes a standard 20 percent coinsurance rate.
MA Also known as Medicare Part C, Medicare Advantage (MA) plans are administered by private companies. Medicare Advantage plans cover the same services as traditional Medicare coverage as well as other benefits. With MA, instead of a standard coinsurance rate, you may be responsible for a larger or smaller percentage, or you may have copays. Most MA plans limit you to a specific set of providers.
Enrollment
AEP During the annual election period (AEP), you can switch between Medicare Advantage and traditional coverage or change to a different MA plan. You can also add or drop Part D coverage. This period is held from October 15 through December 7 each year. It’s also known as Medicare open enrollment.
GEP If you don’t sign up for original Medicare coverage (Parts A and B) when it’s first available to you, you’ll have to wait until a general election period (GEP) to do so. This is held annually from January 1 to March 31. You may face a penalty for having delayed.
IEP The time period during which you can first sign up for Medicare coverage is your initial enrollment period (IEP). It happens in conjunction with your 65th birthday and includes your birthday month, the three months before it and the three months after it, for a total of seven months. If you don’t sign up during your IEP, you may be charged a penalty for late enrollment down the road.
OEP The Medicare Advantage open enrollment period (OEP) can be confusing because it’s not an opportunity to join an MA plan for the first time. Rather, if you already have MA coverage, you can use this time to change or drop your plan. As a change to Medicare in 2019, the OEP will be offered from January 1 through March 31. The Medicare Advantage OEP is replacing the Medicare Advantage Disenrollment Period (MADP). Formerly, MADP was held from January 1 to February 14, and it was only for dropping MA plans. For Medicare 2019, MADP has become an obsolete acronym.
SEP There are exceptions to the typical rules about Medicare enrollment. Loss of job-based coverage or moving from one place to another may qualify you for a special enrollment period (SEP). During this time, you might be able to sign up for Part B, Part D or Medicare Advantage. If you qualify for an SEP, you may not have to pay the penalty for late enrollment.
Health Plans
HMO Many MA plans use a health maintenance organization (HMO) system, in which there is a specific set of providers that you can see for your care. The plan primarily covers treatment received from the providers in that network. A variation known as HMO point-of-service (HMOPOS) may allow you to receive some out-of-network care, but most HMOs don’t cover non-network providers unless it’s an emergency.
PFFS MA plans that are structured similarly to original Medicare coverage are called private-fee-for-service (PFFS). These plans don’t limit you to a specific provider network. However, the providers that you use must be willing to accept the payment terms established by your MA plan administrator.
PPO Like HMO plans, preferred provider organization (PPO) plans feature a set provider network. However, in a PPO structure, you may be able to receive benefits for both in-network and out-of-network care. You’ll be responsible for a smaller portion of your costs when you use in-network providers.

 

 

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