Making sense of Medicare and plan terms and phrases.
Accountable Care Organizations
Accountable Care Organizations (ACOs) are a group of healthcare providers who work together with the goal of coordinating care. Their goal is to make sure each provider you see is up to date on what’s going on with your health. For instance, every provider you see knows what tests you’ve had and conditions you’ve been treated for.
Actual charge is the amount of money a physician or supplier charges for a specific medical service or supply. Since Medicare and insurance companies usually negotiate lower rates for members, the actual charge is often greater than the approved amount that you and Medicare actually pay.
Annual Election Period (AEP)
Annual Election (or Enrollment) Period (AEP) begins October 15 and ends December 7 every year. During AEP, Medicare beneficiaries can enroll, disenroll, or change their Medicare Advantage (MA) plan, Medicare Advantage and Prescription Drug Plan (MAPD), Prescription Drug Plan (PDP), or return to Original Medicare. Elections made during AEP are effective January 1 of the following year.
Annual Notice of Change (ANOC)
The Annual Notice of Change (ANOC)—which is required by Centers for Medicare & Medicaid Services (CMS)—explains any changes in plan benefits, services, and costs for the next calendar year; the information also provides instructions and important deadlines for changing plans and other helpful information. HealthTeam Advantage mails this information to our enrolled members each year before the Annual Election Period (AEP) begins.
An appeal is a request you make if you disagree with our decision to deny an authorization request for services to be received (pre-service), discontinue or stop services being received, deny services already received (claims), or if you disagree with the amount of copayment or coinsurance you are required to pay for services already received (claims). Learn more about Appeals & Grievances here.
When you apply for health coverage you’re required to agree (or attest) to the truth of the information provided by signing the application.
An authorized representative is someone you choose to act on your behalf with the plan, like a family member or other trusted person. Some authorized representatives may have legal authority to act on your behalf. To designate an authorized representative you’ll need to fill out an AOR form (Appointment of Representative) [Click here to go to the AOR form]
This glossary explains terms in the Medicare program, but it isn’t a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.