General Definitions Flashcards
Fee For Service
The amount a provider is paid for each medical service they perform.
Value Based Care
Providers are paid for patient outcomes rather than inputs; doctors and hospitals make more money when they provide proactive care for smaller issues before they become big issues.
Premium
How much you pay automatically each month
Copayments and Coinsurance
How much you pay out of pocket when you use services
Deductible
Amount you have to pay before coverage kicks in
Additional Benefits
Dental, Vision, Hearing aids, Acupuncture etc.
Out of pocket max
The maximum you spend before the plan covers 100% of your costs.
Coverage
The hospitals, doctors, and drugs that your insurance plan will pay towards.
Network
List of doctors and pharmacies that will accept your insurance.
Drug Coverage
The part of insurance that covers some to all of the costs of prescribed medications.
IEP
Initial Enrollment Period. When you first become eligible for Medicare and you can join a plan.
AEP
Annual Enrollment Period. October 15 - December 7 each year, you can join, switch or drop a plan. You coverage will begin January 1st.
MA OEP
Medicare Advantage Open Enrollment Period. January 1 - March 31 each year. If you’re enrolled in a Medicare Advantage Plan, you can switch to different Medicare Advantage Plan or switch to OM once during this time.
SEP
Special Enrollment Period. You can make changes to your Medicare Advantage and Medicare prescription drug coverage outside of the other window when certain events happen in your life. Moving of lose another insurance coverage for example.
