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.
Doug dungeon 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 administrating 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 administrated 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 ungoing 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 hospitice 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 medicines.
Medigap - private insurance that covers the gaps in Part A and Part B coverage. It is also sometimes referred to as Medicare Supplemental 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.
