AEP (Annual Election Period)
October 15th – December 7th. The period of time when you can change your Medicare Health Plan or prescription coverage for the following year.
Annual renewable
Guaranteed benefits for a certain period (usually 1 year).
Coinsurance
An amount you may be required to pay as your share of the cost of services after the deductible. It is usually a percentage.
Co-pay
The amount you pay for a medical service. It is usually a set amount.
Deductible
The amount you pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
DME (Durable Medical Equipment)
Medical equipment ordered by your doctor to use at home. Examples… Walker, Cane, CPAP Machine, etc.
Formulary
List of prescription medications covered by your insurance plan
Formulary Exception
A request for coverage for a non-formulary medication.
Guaranteed renewable
Guaranteed benefits if the premium is paid. Benefits remain the same – the premiums can change.
Max out of pocket
The amount you will pay before your Medicare plan pays 100% of covered health expenses.
Medicare Beneficiary
Individual who is entitled to benefits under Medicare Part A and/or Part B.
Scope of Appointment (SOA)
A CMS requirement of written or verbal consent to discuss health care related (Medicare) products during an appointment.