Sometimes called the annual election period. AEP runs from October 15 through December 7 each year and you make changes to your prescription drug coverage during this time.
This is a document that we will send to you each year in September. It outlines what will be changing about the plan for the upcoming year.
In Original Medicare a benefit period begins on the first day of an inpatient hospital stay and ends when you have been out of the hospital or skilled nursing facility for 60 consecutive days.
The stage in the Part D Drug Benefit where you pay a low copayment or coinsurance for your drugs after you or other qualified parties on your behalf have spent the max amount defined by CMS each year in covered drugs during the covered year.
The Federal agency that runs the Medicare program. In addition, CMS works with the states to run the Medicaid program. CMS makes sure that beneficiaries in both programs are able to get access to high-quality health care.
The percent that you have to pay for a prescription drug. For example, if your coinsurance is 10 percent and the cost of the drug is $10, you will pay $1. With some plans, you do not pay coinsurance until you have first paid a deductible. You can find out if your plan option has coinsurance by referring to the Summary of Benefits.
Copayment is a type of cost sharing and is a fixed dollar amount you pay for prescription drugs. For example, you may pay a $5 copay for a prescription drug. You can find out if your plan option has copayments by referring to the Summary of Benefits.
This is the portion of a prescription drug that you are responsible for paying. Types of cost sharing include copayments, coinsurance or a deductible.
A set amount of money you must pay before you receive any coverage for medical services or prescription drugs. Generally, deductibles are annual and apply to Medicare Parts A, B and D. Deductibles may also apply to Medicare Supplement plans.
The Evidence of Coverage explains your Medicare coverage, what your provider must do, your rights, and what is required of you as a member of our plan. The EOC is updated annually in September and is made available online in the documents section of this website.
The Explanation of Benefits is a statement that you receive every month that you use your Medicare Part D prescription drug benefits. This statement is sent to you by your plan, and provides you with complete information regarding the prescription drug services that you have received. Also included in your EOB are any payments and costs that you are responsible for. The EOB is not a bill, but rather a statement from your plan that is provided for your convenience.
More commonly known as the drug list, the formulary is a list of drugs that are covered by the plan. Blue MedicareRx formularies feature 5 drug tiers, or levels. Generally, drugs on tier 1 are less expensive than drugs on tier 5.
The limit of coverage you receive under the initial coverage stage.
A stage that you enter after your deductible has been met, and before your total drug expenses reach the CMS defined amount. This includes amounts that you have paid, and amounts that your plan has paid on your behalf.
The Initial Election period is a 7-month period of time that begins 3 months prior to your 65th birthday, continues through the month of your 65th birthday, and extends three months after your 65th birthday.
A Medicare Prescription Drug Plan may be either a stand-alone Prescription Drug Plan that you can join if you have Original Medicare or a Medigap/Medicare Supplement plan, or a Medicare Advantage plan (or other health plan) that includes Medicare prescription drug coverage in the plan.
Health insurance policies that typically have standardized benefits and are sold by private insurance companies. Medigap policies work together with your Medicare Part A and Part B coverage. They generally allow you to go to any doctor or hospital that accepts Medicare. There are 10 standard Medigap policies — Plans A, B, C, D, F, G, K, L, M and N. Each plan has a different set of benefits and premiums. Many Medigap plans come with options that allow you to purchase more benefits. Not all health coverage companies offer all 10 plans and, in some states, there are other types of Medigap options. If you choose a Medigap plan and want drug coverage, you must purchase a stand-alone prescription drug plan.
A network pharmacy is a pharmacy that has contracted with our Part D plan, and allows our members to receive their prescription drug benefits.
The part of the Medicare program that provides prescription drug coverage.
This is an amount that may be added to your Part D monthly premium if you didn’t sign up for a Part D plan when you were first eligible. If you had creditable coverage, for example, coverage from an employer or union group, the penalty will not be applied. The penalty amount varies depending on how long you went without Part D coverage. To learn more about the Part D LEP, visit Medicare.gov.
Preferred cost sharing means lower cost sharing for certain covered Part D drugs at certain network pharmacies.
A preferred network pharmacy is a pharmacy that contracts with a Part D plan and allows the plan’s members to receive preferred cost sharing (the lowest possible copays and coinsurance) when filling their prescriptions using their plan benefit in the Initial Coverage stage.
A time not during the annual election period or initial enrollment period when you are able to join, change, or drop your Medicare plan. A SEP can also be triggered by certain events. For example, a change in your residence may result in a SEP.
Standard cost sharing is cost sharing other than preferred cost sharing offered at a network pharmacy.
A standard pharmacy is a pharmacy that contracts with a Part D plan and allows the plan’s members to fill their prescriptions using their plan benefit, but do not offer the same low copayments and coinsurance as a preferred pharmacy.
Teletypewriter (TTY) is a communication tool used by people who are deaf, hard-of-hearing, or who may have a speech impediment.