Common Medicare Terms
- Annual Election Period (AEP). During the AEP, Medicare Advantage-eligible individuals may enroll in or disenroll from an...
- BENEFICIARY. A person who has health care insurance through the Medicare or Medicaid program.
- BENEFIT PERIOD. A “benefit period” begins the day you go into a hospital or skilled nursing facility (SNF). The benefit...
- PLAN SPONSOR.
Full Answer
What are some common medical terminology terms?
Suffixes in medical terminology. Suffixes are attached at the end of words to change or add to the original meaning. In medical terminology, suffixes usually signify a medical condition, surgical procedure, diagnostic term, test information, disease, or part of speech. Some suffixes also signify medical practice or practitioners.
What is Medicare in simple terms?
What is Medicare, and who can get it?
- I am 65 years of age or older.
- I am under 65, but I receive disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB).
- I have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).
- I have end-stage renal disease (ESRD), which is permanent kidney failure that requires a transplant or dialysis.
What are the basics of medical terminology?
Medical terminology is language used to describe anatomical structures, procedures, conditions, processes, and treatments. While medical terms may appear intimidating at first glance, once the basic word structure is understood and the definitions of some common word elements are memorized, the meaning of thousands of medical terms can be easily parsed.
What are the medical terminology words?
Yarlalu Thomas says Lyfe Languages is a “universal medical translator” to help translate complex medical terms into Indigenous languages. Mr Thomas said the program has been in development for the past two years. He said while it started with two ...
What is Medicare medical term?
Medicare. Medicare is the federal health insurance program for: People who are 65 or older. Certain younger people with disabilities. People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
What are the 4 types of Medicare?
There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.
What are the three components of Medicare?
What are the parts of Medicare?Medicare Part A (Hospital Insurance) Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.Medicare Part B (Medical Insurance) ... Medicare Part D (prescription drug coverage)
What are the five types of Medicare?
The 5 Parts of MedicareMedicare Part A (Hospital Insurance) ... Medicare Part B (Medical Insurance) ... Medicare Supplements or Medigap. ... Medicare Part D (Medicare Prescription Drug Coverage) ... Medicare Part C (Medicare Advantage Plans)
What are the two types of Medicare plans?
There are 2 main ways to get Medicare: Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D).
What is Medicare Part C called?
A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare.
What are Medicare Parts A and B?
Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B (Medical Insurance): Helps cover: Services from doctors and other health care providers. Outpatient care.
Which is better PPO or HMO?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
What is Medicare Plan F?
Medigap Plan F is a Medicare Supplement Insurance plan that's offered by private companies. It covers "gaps" in Original Medicare coverage, such as copayments, coinsurance and deductibles. Plan F offers the most coverage of any Medigap plan, but unless you were eligible for Medicare by Dec.
What type of insurance is Medicare?
Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
What is the difference between Medicare and Medicaid?
The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is mainly based on age. But there are special circumstances, like certain disabilities, that may allow younger people to get Medicare.
What is Medicare Plan G?
Plan G is a supplemental Medigap health insurance plan that is available to individuals who are disabled or over the age of 65 and currently enrolled in both Part A and Part B of Medicare. Plan G is one of the most comprehensive Medicare supplement plans that are available to purchase.
What is assignment in Medicare?
Assignment. An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. Top of page.
What is an ABN in Medicare?
Advance Beneficiary Notice of Noncoverage (ABN) In Original Medicare, a notice that a doctor, supplier, or provider gives a person with Medicare before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment.
Can you appeal a Medicare plan?
Your request to change the amount you must pay for a health care service, supply, item or prescription drug. You can also appeal if Medicare or your plan stops providing or paying for all or part of a service, supply, item, or prescription drug you think you still need.
What is Medicare coverage rule?
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.
What is a state medical office?
State Medical Assistance (Medicaid) office. A state or local agency that can give information about, and help with applications for, Medicaid programs that help pay medical bills for people with limited income and resources.
What is SNF in nursing?
Skilled nursing facility (SNF) care. Skilled nursing care and rehabilitation services provided on a daily basis, in a skilled nursing facility (SNF). Examples of SNF care include physical therapy or intravenous injections that can only be given by a registered nurse or doctor.
What is a service area?
Service area. A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it's also generally the area where you can get routine (non-emergency) services. The plan may disenroll you if you move out of the plan's service area.
Is SSI the same as disability?
A monthly benefit paid by Social Security to people with limited income and resources who are disabled, blind, or age 65 or older. SSI benefits aren't the same as Social Security retirement or disability benefits.
What is original Medicare?
Original Medicare is the insurance program managed by the federal government. This type of coverage generally includes Medicare Part A and Part B. Under Original Medicare, the government pays hospitals and doctors directly.
How long does Medicare benefit period last?
A benefit period starts the day you're admitted as an inpatient in a hospital or SNF. It ends after 60 consecutive days without receiving care. Medicare's inpatient hospital deductible is paid at the start of each benefit period. A new benefit period begins when you are admitted to a hospital or SNF after one benefit period has ended. There is no limit to the number of benefit periods.
What is an MSN in Medicare?
MSNs are notices you receive after your doctor or medical supply vendor submits a claim to Medicare for services you received. The Medicare Summary Notice explains what your health care provider or supplier billed Medicare, the Medicare-approved amount, how much Medicare paid and what you must pay.
What is the donut hole in Medicare?
Most Medicare Prescription Drug plans have a gap in coverage, which is also called the " donut hole ." It's a temporary limit on what your drug plan will cover that begins after you and your plan have spent a certain amount on covered drugs. Once you reach the coverage gap, you qualify for savings on both brand-name and generic drugs.
How long can you mail order prescriptions?
Some prescription drug plans and Medicare Advantage Prescription Drug plans offer mail-order programs that allow you to fill a 90-day supply of your covered medications and have them delivered to your home.
What is a Medigap policy?
Medigap is supplemental insurance sold by private insurance companies to fill "gaps" in Original Medicare coverage. These policies help pay for copayments, deductibles and health care when traveling outside the U.S. that Original Medicare does not.
How long is the open enrollment period for Medigap?
The open enrollment period for Medigap plans is a six-month window that starts the first month you become age 65 (or are older) and are covered by Medicare Part B. Coverage is guaranteed during this period. In addition, you cannot be charged more for coverage because of current or past health problems.
When can I sign up for Medicare?
General Enrollment Period: If you miss your Initial Enrollment Period, this is when you can sign up for Medicare. It runs from January 1 through March 31 and is only for first-time enrollees.
When can I enroll in Medicare?
Initial Enrollment Period: Starts three months before your 65th birthday and ends three months after. This is the time that most people will enroll in Medicare.
What is CSNP in Medicare?
CSNP (Chronic Condition Special Needs Plan): A type of Medicare Advantage plan for those with a number of qualifying conditions. Deductible: The amount you have to pay before your coverage begins. Dependents: This does not apply to Medicare.
Is Medicare Supplement a Medicare replacement?
Medicare Supplements: A separate, private insurance plan that can help you pay your Medicare premiums, deductibles, and copayments. This is not a Medicare replacement. Open Enrollment Period (OEP): Runs from January 1 through March 31. Only for switching between Medicare Advantage options.
What is medical care in Medicare?
Medical or surgical care provided at the hospital without the beneficiary being admitted as an inpatient. This includes emergency room care and, per Medicare policy, care provided on observation status, even if the beneficiary remains in the hospital overnight.
What is an actuarially equivalent Part D plan?
An actuarially equivalent Part D plan that is structured differently from the Part D Standard Benefit but that , on a fiscal basis, offers a benefit package at least as valuable as the Standard Benefit. Typically, has a smaller deductible, with or without different cost sharing.
What is an HMO plan?
A type of insurance and Medicare Advantage Plan. Members generally must obtain a referral from their primary care physician in order to see a specialist. with some exceptions Medicare HMOs generally must cover all Medicare Part A and Part B health care. Some HMO's offer additional benefits, such as waiving the three-day qualifying hospital stay for skilled nursing facility coverage. In most HMOs, except in emergency or urgent situations, beneficiaries must receive care from the healthcare providers within the Plan's network.
What is a specialist order?
A written order from a primary care physician to see a specialist. In many Medicare Advantage plans, payment will not be made for specialist care unless the beneficiary first obtains a referral.
What does "care for sudden illness" mean?
Care for a sudden illness or injury that needs medical care right away, but is not life threatening. If a member of a Medicare Advantage plan is out of the plan's service area and requires urgently needed care, the plan must pay for the care.
What is Medicaid in Connecticut?
In Connecticut. Medicaid is also known as Title 19, as it is Title XIX of the Social Security Act.
When do you pay co-insurance for Part D?
Under the standard Part D benefit, once beneficiaries' total Part D drug costs reach a maximum amount, beneficiaries pay only a small co-insurance or co-payment for covered drug costs until the end of the calendar year.
When is the general enrollment period for Medicare?
General enrollment period – This is the period of time to sign up for original Medicare. It runs from January 1 to March 31 each year. A person can use this sign-up period if they miss the IEP.
What is underwriting for Medicare?
Underwriting – This involves a full review of a person’s medical history to determine the premiums they should pay. Sometimes, this can lead to Medicare or the private insurer excluding certain medical conditions from the coverage they offer.
When does the OEP start for Medicare?
OEP – For Medicare Advantage and PDPs, the OEP runs from October 15 to December 7 each year. For Medigap, the OEP is the 6-month period that runs from the month a person turns 65 years of age and signs up for Medicare Part B.
What is special enrollment period?
Special enrollment period – This is an opportunity to sign up for original Medicare under certain circumstances, such as when a person’s employee health insurance coverage comes to an end.
What is ALS in Medicare?
Amyotrophic lateral sclerosis (ALS) – Also known as Lou Gehrig’s disease, this is a progressive neurological condition. People with ALS who receive Social Security (SS) disability benefits are eligible for Medicare parts A and B.
How long does it take to sign up for Medicare?
IEP – This is the 7-month period in which a person can sign up for original Medicare. The IEP begins 3 months before a person turns 65 years of age, includes the month of their birthday, and ends 3 months later.
What is a PDP formulary?
Formulary – This refers to a list of prescription drugs that a PDP covers. A formulary includes at least two of the drugs most commonly prescribed within each drug class.
