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Advanced Coverage Decision
A notice from a Medicare Advantage plan (Not traditional Medicare) in advance stating If a specific service is covered.
Ambulatory Surgical Center
A medical facility that performs relatively simple surgical procedures that patients are not expected to require more than 24 hours of care.
Appeal
An action you can take when you disagree with a coverage decision made by an insurance company, Medicare, a Medicare health plan, or a prescription drug plan.
Claim
A request made by you to your insurance provider or Medicare when you receive services that you think are covered.
Coinsurance
A share in the cost of services after meeting your deductible, usually expressed as a percentage, that you may be required to pay for services received.
Copayment
A specific dollar amount that your expected to pay for when receiving services such as a doctor's appointment, a visit to an outpatient hospital facility, or when picking up a perscription.
Coverage Gap
(Medicare Prescription Drug Plan)
A period of time when you pay a higher share of the cost for prescription drugs until you qualify for catastrophic coverage. This coverage gap is also known as the "donut hole" for coverage under a Medicare Prescription Drug Plan and ends when you reach a set dollar amount of spending on prescription drugs.
Deductible
The amount you must pay for healthcare and prescriptions before your insurance plan, Medicare, or prescription drug plan starts paying.
Healthcare Savings Account (HSA)
Savings accounts for individuals with high deductible health insurance plans. Contributions can be made by individuals or their employer that can be invested and grow tax deferred. The savings can be used for qualified medical expenses with no tax penalties.
Independant Reviewer
Also known as an Independant Review Entity (IRE), this is an organization that Medicare contracts with to act as a third party to review appeals.
Long-term Care Insurance
Insurance plans that help pay for long-term care which is non-medical care that focuses on daily living activities either in a nursing home or at the patient's home. Long-term care services are not covered by medicare and policies vary greatly in coverage and price.
Living Will
Also known as a medical or advanced directive, this is a legal document that states your wishes regarding life support and certain medical conditions usually occurring at end-of-life situations
Medicaid
A state and federal program that assists individuals that have low-incomes and limited resources with medical expenses and insurance coverage.
Medicare
A Federal insurance program that is administered by the Centers for Medicare and Medicaid Services (CMS). This insurance program aims to provide healthcare coverage for people over age 65 and for those with certain health conditions or disabilities.
Medicare Certified Provider
A healthcare provider that has been certified and approved by Medicare. A healthcare provider has to be certified in order to accept Medicare insured patients.
Medicare-Part A
Part A of Medicare is also known as hospital insurance. This aims to provide insurance coverage for In-patient hospital care, skilled nursing facility care, hospice, and home-healthcare services.
Medicare-Part B
Part B of Medicare is the component of Medicare the provides coverage for medically necessary services and preventive medical services for those who qualify.
Medicare-Part D
An insurance provided by companies that contract with the federal government to offer coverage for prescription drugs for Medicare recipients.
Medicare Advantage Plan
An HMO, PPO, or Private Fee for Service insurance plan that contracts with Medicare to offer a potentially more comprehensive insurance coverage plan than traditional Medicare for those aged 65 and older. Caution is warranted when choosing these plans instead of traditional Medicare because these plans can be restrictive with which healthcare providers and services that are covered.
Medi-Gap Insurance Plan
Supplementary private health insurance products for traditional Medicare recipients to increase health coverage.
Penalty
A fee added to the monthly premiums for Medicare Part B or Medicare Part D, when an individual did not sign up for those respective programs when they were first eligible. This fee amout is added onto the monthly premium for as long as they are insured by Medicare.
Power of Attorney
A medical power of attorney is a legal document that allows you to appoint someone to make medical decisions for you. Other terms for this are healthcare proxy, a durable power of attorney for healthcare, and appointment of healthcare agent.