Understanding Common Medicare Acronyms

Understanding common Medicare acronyms is important weather you are getting ready to sign up for Medicare or a Medicare agent. As in any business, understanding the terminology is essential to help navigate the system.

General Medicare Terms

• CMS: Centers for Medicare & Medicaid Services
  The federal agency that administers the nation’s major healthcare programs, including Medicare and Medicaid.
• SSA: Social Security Administration
  The government agency responsible for administering Social Security benefits, including the processing of Medicare applications.

Parts of Medicare

1. Part A: Hospital insurance covers inpatient hospital stays, skilled nursing facility care, hospice care and some home health services.
2. Part B: Medical Insurance covers outpatient care, doctor services, preventative care and DME.
3. Part C: Medicare Advantage plans are an alternative to Original Medicare. They provide the same coverage as Original Medicare and often some added benefits. Private insurance companies offer these plans.
4. Part D: Prescription Drug Plans provide coverage for approved prescription medications. Private insurers offer these plans.

Medicare Plan Types

• MA: Medicare Advantage also called Part C provide the same benefits as Original Medicare (Part A & Part B).
• MAPD: Medicare Advantage Prescription Drug Plan provide the benefits of Original Medicare as well Part D.
• PDP: Prescription Drug Plan provides stand alone coverage of prescription drugs under Medicare Part D.
• HMO: Health Maintenance Organization is a type of Medicare Advantage plan. These plans require members to use a specific network of providers and referrals for specialists.
• PPO: Preferred Provider Organization is a type of Medicare advantage plan that offers out of network coverage. They are a more flexible option than an HMO.
• PFFS: Private Fee-For-Service is another type of Medicare advantage plan. It allows beneficiaries to see any doctor or hospital that accepts the plan’s terms. The costs and coverage are set by the plan.
• MSA: Medical Savings Account combines a high-deductible Medicare advantage plan and a savings account. The plan deposits money into the account each year to pay healthcare expenses before beneficiaries meet the deductible amount.
  

Enrollment Periods

• AEP: Annual Enrollment Period occurs from October 15 to December 7 annually. During this time, beneficiaries can enroll in or change their Medicare coverage.
• ICEP: Initial Coverage Election Period is the period when individuals first become eligible for Medicare benefits.
• SEP: Special Enrollment Period occurs outside normal enrollment periods and provides an opportunity to change plans due to a specific event. This includes things like moving or losing employer sponsored health coverage.

Learn more about Medicare enrollment periods

Notices and Forms

• ANOC: Annual Notice of Change
  A document sent by Medicare plans outlining any changes in coverage, costs, or service areas for the upcoming year.
• EOC: Evidence of Coverage
  A document detailing what the plan covers, how much members pay, and other rights and responsibilities.
• ABN: Advance Beneficiary Notice of Noncoverage
  Is a waiver of liability. A notice given to beneficiaries of Original Medicare when a service or item isn’t expected to be covered, allowing them to decide whether to receive and pay for the service.

Assistance Programs

• LIS: Low-Income Subsidy
  Also known as “Extra Help,” this program assists individuals with limited income in paying for prescription drug costs under Part D.
• MSP: Medicare Savings Program
  State programs that help pay Medicare premiums and, in some cases, deductibles and coinsurance for individuals with limited income.

A few more terms

• DME: Durable Medical Equipment
  Medical equipment like wheelchairs, walkers, or hospital beds that are ordered by a doctor for use in the home.
• EOB: Explanation of Benefits
  A statement from a Medicare plan detailing what was billed, what Medicare paid, and what the beneficiary may owe.
• HIPAA: Health Insurance Portability and Accountability Act
  A federal law that, among other things, protects the privacy of individuals’ health information.

Being well informed helps ensure that beneficiaries and professionals can navigate the Medicare system effectively.