Sunday, May 29

Definitions Of The Most Common Medicare Terms

There are a number of Medicare terms that everyone should know if they are policy holders or are about to be. We have listed the more common ones below.

Appeal – a formal complaint that an individual files if certain drugs and services are not covered by their particular Medicare plan when they feel that they should be.

Co-pay – the portion of any medical services and/or prescription medications that you are responsible for paying.

Deductible – the amount of money that must be paid by the insured for medical care before Medicare covers any such expenses.

Doughnut hole – the coverage gap found in some Medicare drug plans (scheduled to close in 2020).

Dual eligibility – refers to being eligible for both Medicaid and Medicare.

Enrollment period – the limited time period that an individual can enroll in a health care plan or switch to a different one.

Grievance – a formal complaint made to Medicare when your health care plan or the person administering medical treatment to you has treated you improperly or poorly.

Home health care – short-term care provided while you are recovering at home from an illness or injury. Occasional part-time skilled care as well as some medical equipment, services, and supplies are included in a home health care plan.

Hospice care – care administered to those individuals with a terminal illness or medical condition (covered in Part A). Counseling and physical care are included.

Long-term care – Medicare does not cover ongoing health or personal care that an assisted living facility or a nursing home would provide.

Medicaid – federal and state programs that are separate from Medicare. This assists those individuals with limited assets and low incomes to pay for their medical expenses.

Medicare Advantage – alternative health care for Parts A and B that are provided by a private insurance carrier.

Medicare Part A – pays for hospice care, hospital stays, and some home health care.

Medicare Part B – pays for lab tests, medical equipment, physician visits, and some medical services.

Medicare Part D – coverage that is provided for some brand name and generic medications.

Medigap – private insurance that covers the gaps in Part A and Part B coverages. It is also sometimes referred to as Medicare Supplement Insurance.

Out-of-pocket expenses – those expenses that you are responsible for and are not covered by Medicare insurance.

Premiums – payments for health care coverage that is usually made on a monthly basis.

Skilled nursing care – medical care provided by licensed LPN’s (Licensed Practical Nurses) or RN’s (Registered Nurses).

For more information, the entire Medicare glossary is available online at the US Government Site for Medicare.