A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Coinsurance
The amount you may have to pay after you pay any plan deductibles.
Copayment
A set dollar amount you pay for each health care service like a doctor’s visit or prescription filled.
Custodial Care
Personal, non-medical care that assists individuals with dietary needs, self-administration of medication and other activities that take place in daily life.
Deductible
The amount you must pay for health care before Medicare begins to pay, either for each benefit period for Part A or each year for Part B. These amounts can change every year.
Donut Hole/Coverage Gap
Most Prescription Drug Plans (Medicare Part D) have a temporary limit on what the plan will cover for drugs. In 2015, you will pay 100% of drug costs between $2,960 and $4,700. Once your costs hit the first part of the limit ($2,960 in 2015), Medicare provides $0 in drug benefits until you get to the top of the limit ($4,700 in 2015). If you get additional coverage, this upper limit can change.
Formulary
A formulary is a list of covered drugs under a Medicare Advantage Part D Plan. The list includes both brand name and generic drugs. In some Medicare health plans, doctors must order or use only drugs listed on the health plan’s formulary
Generic Drug
A generally less expensive alternative designed to be a copy of brand name drugs in safety, form, dosage, strength, quality and performance characteristics. They are rated by the Food and Drug Administration (FDA) to be as effective as the brand name version.
HMO
A type of Medicare managed care plan where a group of doctors, hospitals and other health care providers agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. You usually must get your care from the providers in the plan.
Home Health Agency
Offering a variety of home care services, this organization provides nursing care, occupational, speech and physical therapy as well as social services.
Hospice Care
Covered under Medicare Part A, this type of service focuses on caring for people who are terminally ill and their family. It is designed to comfort, and offers resources for physical, mental and emotional support.
Initial Enrollment Period
This is the first chance you have to enroll in Medicare. It occurs the three months before you turn 65, the month you turn 65 and the three months after you turn 65.
Medicaid
Supplies health care services to low-income Americans.
Medicare Coverage
Made up of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). (See Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).)
Medicare Part A
The part of Medicare that covers hospital visits, nursing facilities, hospice care and certain home health care. Most people don’t pay a premium for Part A because they, or their spouse already paid for it through their payroll taxes while working.
Medicare Part B
This portion of Medicare deals with medical insurance and helps cover outpatient hospital care, doctor and specialist treatment, medical equipment and additional services that aren’t covered by Part A. For this insurance, most people pay a monthly premium, which covers care you’ll receive from your doctors and other health care providers.
Medicare Part C
Also known as Medicare Advantage plans, these consist of a wider set of options for getting the health care you need. Everyone who is eligible for Medicare, qualifies for Part A and enrolls in Part B can enroll in a Medicare Advantage plan. Private insurance companies like BCBS of Massachusetts offer these plans and, by law, they must offer the same benefits as Original Medicare and can also offer you additional benefits as well.
Medicare Part D
This part of Medicare provides prescription drug benefits. This coverage option can help lower your current prescription drug costs and keep you from having to pay higher costs in the future. These plans are only available through private insurance companies, like us.
Medicare-Approved Amount
This is the set amount that a doctor or other provider who accepts Medicare can be paid for the service rendered. Medicare will pay part of the amount, and you’re responsible for the difference. It could be less than the normal amount the provider would charge.
Medigap Policy
Medicare supplement insurance is a Medigap policy. It is sold by private insurance companies to fill gaps in Original Medicare plan coverage. Medigap policies only work with the Original Medicare plan.
Original Medicare
A federally funded fee-for-service health plan that lets you go to any doctor, hospital or other health care supplier who accepts Medicare and is accepting new Medicare patients.
PPO (Preferred Provider Organization)
A type of Medicare Advantage plan in which you use doctors, hospitals and providers that belong to the network. You can use doctors, hospitals and p
Part B Premium
The amount most people are required to pay each month for their Part B coverage. Even with a Medicare Advantage or Medicare supplement plan, you will be expected to keep paying your Part B premium.
Premium
The periodic payment to Medicare, an insurance company or a health care plan for health care or prescription drug coverage.
Primary Care Doctor
A doctor who is trained to give you basic care. In many Medicare managed care plans, you must see your primary care doctor before you see any other health care provider.
Referral
Your doctor may give you a written notice to go see a specialist for certain services that they may be unable to perform.
SNP (Special Needs Plan)
As part of a Medicare Advantage plan, this option is for people with certain diseases who need coverage, benefits, provider options and prescription medication that fit their specific health care needs.
Skilled Nursing Facility
Part of Medicare Part A, under certain conditions like needing custodial care or physical therapy, a rehabilitation or nursing staff will provide you with daily support and services.
TDD/TTY
Known as Teletypewriter (TTY), or Telecommunication Device for the Deaf (TDD), this communication platform is for those who have difficulty speaking, hearing or who are deaf. By calling these numbers, you will be connected to operators who can communicate back and forth using this specific type of messaging.
