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Medicare Part D Glossary

OEP or "Open Enrollment Period"
Starting in 2011, the annual Open Enrollment Period begins on October 15th and continues through December 7th. During the Open Enrollment Period, Medicare beneficiaries can add, change, or drop their Medicare Part D or Medicare Advantage plan coverage. Changes in Medicare plan coverage during the Open Enrollment Period will take effect on January 1st. After the close of the Open Enrollment Period, people will only have a limited opportunity to change their Medicare Part D or Medicare Advantage plan coverage until the next Open Enrollment Period. Although probably not universally accepted, we abbreviate the annual Open Enrollment Period as OEP and use the abbreviation in place of AEP (Annual Enrollment Period or Annual Coordinated Election Period).

Starting in 2019: The 21st Century Cures Act eliminates the existing MA disenrollment period [MADP] that takes place from January 1st through February 14th of every year and, replaces it with a new Medicare Advantage open enrollment period (MA-OEP) that will take place from January 1st through March 31st annually.

2011-2018: The Medicare Advantage Disenrollment Period (MADP) runs for 45 days from January 1st through February 14th and allows people enrolled in a Medicare Advantage plan (Part C) an opportunity to leave their Medicare Advantage plan, return to Original Medicare, and join a stand-alone Medicare Part D prescription drug plan (even when the Medicare Advantage plan did not include prescription coverage). Note: Through the new Health Care Reform, the former Medicare Advantage plan Open Enrollment Period (Jan. 1 - Mar. 31) was eliminated and replaced with the MADP.

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 beneficiaries 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.

Original Medicare
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).

out-of-network benefit
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.

out-of-pocket costs
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 $8000, 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:
    1. plan premiums,
    2. drugs not covered by our plan;
    3. non-Part D drugs (such as drugs you receive during a hospital stay);
    4. drugs covered by our plan’s Supplemental Drug Coverage;
    5. 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

outpatient services
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.

outpatient services maximum
The annual maximum amount the plan pays toward outpatient services.

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.