AEP- Annual Election Period
The time from October 15 to December 7 each year when changes may be made in Medicare Advantage Plan (Part C) and Prescription Drug Plan (PDP) selections.
Baby Boomers
A statistical cohort of the American population consisting of those born from 1946 to 1962.
Coinsurance
A cost sharing provision of an insurance contract consisting of a percentage of the expenses covered by the insurance, to be paid by the insured or policy owner.
Commission
Compensation paid to a licensed agent by an insurance company, as an inducement to place business with them.
Co-pay
A cost sharing provision in an insurance contract consisting of a flat dollar amount charged to the insured or policy owner each time a specified event occurs.
Cost Sharing
Elements of an insurance contract that cause the insured or policy owner to pay a portion of the covered charges. Their existence reduces the cost of the product and discourages high utilization.
Deductible
Cost sharing provision in an insurance contract whereby the insured or policy owner pays a fixed dollar amount before the insurance company begins to pay its share of a claim.
High Deductible
Indicative of a larger than expected cost the insured must pay before the insurance company is obligated to start paying its contractual share of a claim.
Destitute
Financially distressed, without sufficient resources to pay routine expenses.
Donut Hole
A coverage gap in most Prescription Drug Plans during which the insured or policy owner must pay all costs.
Effective Date
The date on which insurance coverage begins, usually at 12:01 AM and, for Medicare coverages, usually on the 1st of a month.
Enrollment
The act of providing identifying information and committing to an agreement with an insuring entity for coverage.
Late Enrollment occurs after a deadline has been missed.
Formulary
List of approved drugs drawn up by an insurance company as part of its Prescription Drug Plan.
Guaranteed Issue
The legal right to coverage that an insurance company cannot contest if the insured meets a few conditions.
Health Insurance
A legal contract wherein an insuring entity is obligated to reimburse expenses incurred for medical treatment by an insured person.
HDF
Abbreviation for High Deductible Plan F.
HMO Network
Health Maintenance Organization of medical providers that insured people must use in order to receive reimbursement from the insurer for costs of medical treatment.
HSA – Health Savings Account
Health insurance plan typically having a very high deductible and a side fund into which pre-tax contributions may be used to defray out-of-pocket expenses to be paid by the insured.
ID Card
Identification cards provided to insured persons who present them to medical providers. The cards prove that coverage is in effect and show contact information to facilitate payment.
Infirm
A state of weakness and/or ill health due to age or disease.
IRMAA
Income Related Monthly Adjustment Amount, a surcharge on certain insurance premiums assessed to those with high income as reported to the IRS in a prior year.
Leech
A person who extorts a profit from or sponges off others.
Medicaid
A state program of welfare that seeks to provide medical care to low income and indigent residents.
Medical Underwriting
An assessment of the insurability of an applicant based on the state of health and health history of that person.
Medicare
A universal health insurance program provided and administered by the Federal government for Americans age 65+ and those suffering from certain medical conditions and disabilities.
Medicare Advantage Plan
Health insurance sold by insurance companies that takes the place of Medicare and pays some of the costs of medical treatment of Medicare participants.
Medicare Parts
A: Coverage for inpatient treatment in hospitals, nursing facilities, etc. for Medicare participants.
B: Coverage for outpatient treatment in doctors’ offices, clinics etc. for Medicare participants.
C: Medicare Advantage Plans
D: Prescription Drug Plans
Medicare Supplement Plan
Health insurance sold by insurance companies that supplements original Medicare and pays some of the costs of medical treatment of Medicare participants.
Network
Typically a Preferred Provider Organization or a Health Maintenance Organization of medical providers contracted with an insuring entity.
Open Enrollment
A period of time during which certain qualified applicants for insurance will be accepted for coverage without regard to health history or current medical condition.
Out-of-pocket limit
A cost sharing provision that imposes an upper limit to the financial payment an insured person or policy owner must pay before the insuring entity reimburses 100% of costs.
Plan F; High Deductible Plan F (HDF)
Two of the array of Medicare supplement plans available for purchase from insurance companies to help defray the impact of cost sharing provisions in original Medicare.
PPO Network
Preferred Provider Organization of medical practitioners that insured people must use in order to receive maximum reimbursement from the insurer for costs of treatment. Charges arising from treatment by non-network providers are reimbursed at lower levels.
Premium
The price of insurance charged for coverage to the insured or policy owner. Often expressed as a monthly cost.
Prescription Drug Plan - PDP
Insurance sold by private companies to defray part of the cost of prescription medication for Medicare participants. Also referred to as Part D and PDP plans.
Provider
A practitioner or facility licensed to provide medical treatment and to charge fees for services rendered.
Sapperticker, Hooty
A fictional character immortalized on WLS in the 1960s with an effort to create a national holiday in his honor on June 22nd. He was the subject of two short pop songs, the least bad of which is here:
http://blogfiles.wfmu.org/BU/Andy_Rose_and_the_Thorns_-_Hooty_Sapperticker.mp3
Apparently, the other song was a favorite of both Dr. Demento and humor writer Dave Barry.
