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| OEP or "Open Enrollment Period" |
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Starting in 2011, an individual enrolled in a Medicare Advantage plan (Part C) may return to Original Medicare and a stand-alone Part D plan during the first 45 days of the year. Note: Through the new HealthCare Reform, the Medicare Advantage plan Open Enrollment Period (Jan. 1 - Mar. 31) has been eliminated.
2006-2010: Running from January 1 until March 31, Medicare beneficiaries can make additional choices regarding Medicare Advantage plans. Medicare beneficiaries who have both Medicare A and Medicare B, and who have enrolled in a Medicare Part D plan (PDP) can switch to a Medicare Advantage plan (MA-PD) - Please note however, in the OEP, you may not move to another stand alone PDP. Medicare Beneficiaries who already have a MA-PD can switch to another MA-PD or they can switch back to traditional Medicare and a stand-alone PDP. MA-PD members are not allowed to switch to a MA plan without a prescription drug plan. If a Medicare Beneficiary is in a MA plan without prescription drug coverage, they are not able to switch to a MA-PD (Medicare Advantage plan with prescription drug coverage). Related to this word are AEP, IEP, and SEP.
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| Original Medicare |
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The term "Original Medicare" is often used to describe your normal Medicare A and B benefits. If you have Medicare Part A and/or B coverage you can purchase a Medicare Part D (PDP) plan. If you have Medicare A and B you can also purchase a Medicare Supplement to cover a portion of the costs not covered by Original Medicare or you can enroll in a Medicare Advantage Plan (with or without Prescription Drug coverage).
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| out-of-network benefit |
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Generally provides a beneficiary with the option to access plan services outside of the contracted provider network. In some cases, a beneficiary's out-of-pocket costs may be higher for an out-of-network benefit.
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| out-of-pocket costs |
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The amounts the beneficiary pays as their share of prescription drug costs in a Part D plan. Deductibles, co-insurance, and the amounts paid during the doughnut (donut) hole or "coverage gap" make up the total out-of-pocket costs. The out-of-pocket costs are called "true out-of-pocket costs," or "TROOP." When each beneficiary "true out-of-pocket costs" exceed $4550, they are eligible for the catastrophic coverage phase of a Part D plan.
"Out of pocket costs" include:
- What you pay when you fill or refill a prescription for a covered Part D drug. (This includes payments for your drugs, if any, that are made by family or friends.)
- Payments made for your drugs by any of the following programs or organizations: "Extra Help" from Medicare, Medicare’s Coverage Gap Discount Program; Indian Health Service; AIDS drug assistance programs; most charities, and most State Pharmaceutical Assistance Programs (SPAPs).
Do NOT include:
- Payments made for:
- plan premiums,
- drugs not covered by our plan;
- non-Part D drugs (such as drugs you receive during a hospital stay);
- drugs covered by our plan’s Supplemental Drug Coverage;
- drugs obtained at a non-network pharmacy that does not meet our out-of-network pharmacy access policy.
- Payments made for your drugs by any of the following programs or organizations: employer or union health plans; some government-funded programs, including TRICARE and Veteran’s Administration; Worker’s Compensation, and some other programs
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| outpatient services |
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Services that do not take place as an in-patient in the hospital. They may be provided in clinics or provider officers, ambulatory surgical centers, hospices, home health services, and so forth.
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| outpatient services maximum |
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The annual maximum amount the plan pays toward outpatient services. |
Enroll 2010
