Open Enrollment Period Official Definition: “CMS defines the Medicare Advantage Open Enrollment Period as a period from January 1 – March 31 each year. If you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage...
Medicare Official Definition: “Per CMS, Medicare provides health insurance coverage to individuals who are age 65 and over, under age 65 with certain disabilities, and individuals of all ages with ESRD. Medicaid provides medical benefits to groups of...
Explanation of Benefits Official Definition: “CMS states that each month you fill a prescription, your Medicare Prescription Drug Plan mails you an “Explanation of Benefits” (EOB). This notice gives you a summary of your prescription drug...
Evidence of Coverage Official Definition: “CMS explains that if you’re in a Medicare plan, your plan will send you an “Evidence of Coverage” (EOC) each year, usually in the fall. The EOC gives you details about what the plan covers,...
Step Therapy Official Definition: “CMS defines Step Therapy as a coverage rule used by some Medicare Prescription Drug Plans that requires you to try one or more similar, lower cost drugs to treat your condition before the plan will cover the prescribed...
Drug Tiers Official Definition: “CMS defines Drug Tiers as an option to allow plans the ability to group different drug types together (i.e., Generic, Brand, Preferred Brand). In this regard, tiers could be used to describe drug groups that are based on...