 Here we are again approaching Medicare’s AEP (Annual Election Period Oct. 15th – Dec. 7th) where beneficiaries are allowed, encouraged even, to compare their current Medicare plan with the other options out there. Since we’ve covered the History of Medicare, offer Medicare information and FAQ’s on our site, and have given you a brief Understanding of Medicare, I thought this would be a good time to address the acronyms used by CMS and different Medicare plans as well as changes for the upcoming year (2019). Let’s start at the beginning with CMS; the Center for Medicare and Medicaid Services is the government agency that oversees and regulates many federal healthcare programs.
Your IEP; Initial Enrollment Period – this is the 7-month window in which you are “aging in” (turning 65) and eligible to sign up for a Medicare plan. Once you’re established with a Medicare Insurance plan, there are certain situations that throw you into a SEP (special enrollment period). We discussed some of those in our Understanding Medicare post, so I won’t go into them again here. One thing I will mention though, is the term Low Income Subsidy or LIS. There are programs out there to help Medicare beneficiaries who fall into certain income brackets receive help with their Medicare prescription drugs (Part D). Check with your local Social Security Office to see if you are eligible. When deciding on the type of Medicare insurance you desire, it is important to know the different options available. A *Med Supp (Medicare Supplement) plan works with Original (or traditional) Medicare to cover your hospital, doctor and other healthcare related visits. Medicare supplements are also known as Medigap. A **SNP (special needs plan) is designed for people with special healthcare conditions (EX: Diabetes & Heart Disease)– most are HMO plans. Those members/beneficiaries who are eligible for both Medicare and Medicaid would more than likely get a **DSNP (dual-eligible special needs plan). Much like the SNP, a **CSNP plan is designed for people with chronic special needs – however in most instances, a CSNP policy can be written for folks who don’t qualify for Medicaid but are on Medicare and have chronic illnesses like those listed above. A *MA (Medicare Advantage) plan works like traditional health insurance, meaning the plan or company (EX: Humana, Aetna, United Healthcare, etc.) pays your claims instead of “traditional” or “original” Medicare itself, which is paid through the Federal Government. A MA only plan does not cover your prescription drug costs, however, a *MAPD (Medicare Advantage/Prescription Drug) plan does. When choosing a MA or MAPD plan, it is important to understand the type of plan you’re getting, whether a HMO, PPO, or PFFS. A *HMO (health maintenance organization) is an “in network only” plan which basically means your health care must be handled within the organizations network of doctors, hospitals and other healthcare providers. HMO-POS (health maintenance organization with point of sale option) is an HMO plan with a more flexible network which allows its plan members to see an OON (out-of-network) provider for certain conditions or treatments. You can expect to pay more out of pocket costs when receiving treatment out of the network and pre-authorization is usually required. Similar to the HMO, a *PPO (preferred provider organization) also has a network of preferred doctors and hospitals, etc., but has more leeway when a patient chooses to receive care outside of the network. A *PFFS plan allows the patient to receive treatment from any doctor or hospital that accepts Medicare as well as the payment terms and conditions of the plan. Out of pocket costs brings up two more acronyms you should be aware of: MOOP and TrOOP. MOOP is the “maximum out of pocket” expenses you will pay (in accordance with your Medicare Insurance Plan), in a calendar year for deductibles and co-insurance. TrOOP is the “total or true out of pocket” expenses you will pay when it comes to your Part D (prescription drug) costs. There is one more acronym I want to bring to your attention that’s new for 2019 and that is Medicare’s OEP (open enrollment period). Previously the MADP “Medicare disenrollment period” (Jan. 1st through Feb. 14th) allowed the beneficiary to change from his or her MA plan back to Original Medicare (with or without drugs). In 2019 the OEP “open enrollment period” (Jan 1 – March 31) goes into effect and allows a beneficiary to switch from a MA or MAPD back to Original Medicare (with or without drugs) OR switch from one MA or MAPD plan to another. Keep in mind, however that you only get one opportunity to switch. As always, there are exceptions and stipulations for each individual Medicare company and plan, so it is always in your best interest to visit with a licensed/trained agent to assure you know and understand what you’re getting, so give us a call! We’d be happy to help. Until later take care and remember, information is knowledge and knowledge is power. Tommy Curtis and Staff *Covered benefits/charges vary by company/plan ** SNP, DSNP and CSNP plans are not available in all areas. Disclaimers:
Life and Medicare Products marketed through Curtis & Associates Financial Services, Inc. {A Life and Health Agency} Comments are closed.
|
Tommy Curtis
Is an insurance agent with integrity and your best interest in mind. Call to speak directly to him. Contact us Phone: 337-433-1683 Address: 509 7th Street Lake Charles, LA 70601 Office Hours: M-F 9a - 5p (CST) Follow Us
|
RSS Feed