|» OEP or "Open Enrollment Period"||» out-of-pocket costs|
|» Original Medicare||» outpatient services|
|» out-of-network benefit||» outpatient services maximum|
|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).
Also beginning in 2011, 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.
|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).
|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.
|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 $5100, they are eligible for the catastrophic coverage phase of a Part D plan.
"Out of pocket costs" include:
|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.|