Did you just say I need a PCP with my MA plan or MAPD plan if it is an HMO, but not if it is a PPO, and if I have a MA plan I can’t have a stand-alone PDP unless it is a PFFS?

All too often individuals working with specific areas of insurance become comfortable with abbreviations and don’t realize they are overusing them. It is not at all that the individual is being inconsiderate or expecting you to know what the abbreviations mean, but they have incorporated them into their daily language almost as if they were a part of the everyday English language. If you fall victim to someone who uses abbreviations that you do not know the meaning, do not hesitate to ask them to explain the meanings of the abbreviations. If you should fall victim to an individual who is rattling off Medicare associated abbreviations, the following list of the most frequently used abbreviations and their means will help you interpret and understand what he or she is saying to you. The information will also prove helpful in reading Medicare related literature such as brochures, insurance forms and applications, articles and publications. 

ADP Annual Disenrollment Period

AEP Annual Election Period

CMS Center for Medicare and Medicaid Services

COBRA Consolidated Omnibus Budget Reconciliation Act

DOB Date of Birth

DOS Date of Service

DVH Dental/Vision/Hearing

ECF Extended Care Facility

EFT Electronic Funds Transfer

EOB Explanation of Benefits

ESRD End Stage Renal Disease

F&A Fraud and Abuse

FOI Freedom of Information

FOIA Freedom of Information Act

HHS Health and Human Services (CMS is a branch of)

HIPPA Health Insurance Portability and Accountability Act

HMO Health Maintenance Organization

HRSA Health Resources Services Administration

ICEP Initial Coverage Election Period

ID Identification

IEP Initial Election Period

IOM Internet-Only Manual

IRMMA Income Related Monthly Adjustment Amount

IVR Integrated Voice Response System

LIS Low Income Subsidy

LOC Loss of Coverage

MA Medicare Advantage plan

MAPD Medicare Advantage with Prescription Drug plan

MEDPARD Medicare Participating Physician/Supplier Directory

MedSupp Medicare Supplement plan

MMA Medicare Modernization Act

MOV Move (creation of Special Election Period)

NON Nonrenewing

NON-PAR Non-Participating Provider

OEPI Open Election Period Institutionalized

OTC Over-the-Counter

PAR Participating (physician)

PCP Primary Care Physician (for an HMO)

PDP Prescription Drug Plan

PFFS Private Fee-For-Service

POS Place of Service or Point of Service (for an HMO)

PPACA Patient Protection and Affordable Care Act

PPO Preferred Provider Organization

PPV Pneumococcal Pneumonia Vaccine

QMB Qualified Medicare Beneficiary

RRB Railroad Retirement Board

Rx Prescription

SEP Special Election Period

SHIP Senior Health Insurance Program or State Health Insurance (Assistance) Program

SMI Supplemental Medical Insurance

SNF Skilled Nursing Facility

SNP Special Needs Program

SPAP State Pharmaceutical Assistance Program

SSA Social Security Administration

SSI Supplemental Security Income

SSN Social Security Number

TIN Taxpayer Identification Number

USC United States Code

VA Veterans Administration

 

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