A
Accreditation
Advance Beneficiary Notice (ABN)
If you accept an ABN by signing it and Medicare denies payment, you will probably have to pay for the product or service.
ABN’s only apply if the beneficiary is enrolled in Original Medicare Parts A and B
Advance Coverage Decision
This is not related to an ABN which only applies to Original Medicare.
ALS
Angina pectoris
Angioplasty
Appeal
Assignment
(Medicare Glossary by LifeSmart)
B
Beneficiary
Benefit Period
You must pay the hospital deductible for each benefit period – there is no limit to the number of benefit periods.
Benefits
(Medicare Glossary by LifeSmart)
C
Center for Medicare and Medicaid Services (CMS)
Certified (certification)
CHAMPVA
Children's Health Insurance Program (CHIP)
Claim
Clinical Breast Exam
Coinsurance
Comprehensive outpatient rehabilitation facility
Coordination of benefits
Copayment
Coronary stent
Cost Sharing
Coverage Determination (Part D)
- Is a particular drug covered?
- Have you met all the requirements for obtaining that drug?
- How much you are required to pay for that drug?
You are entitled to a prompt decision about the drug and you can appeal an unfavorable decision.
You are advised to call or write to your provider in this regard.
Coverage gap (Medicare prescription drug coverage - Part D - Donut Hole)
This requirement will be completely phased out in 2020 – at this stage you will pay no more than 25% of the costs of your drugs throughout the entire year. Medicare Glossary.
Creditable coverage (Medigap)
Creditable prescription drug coverage
Critical access hospital (CAH)
Custodial Care (non-skilled personal care)
Medicare does not cover custodial care.
(Medicare Glossary by LifeSmart)
D
Deductible
Deemed Status
Demonstrations
Dental Coverage
(Medicare Glossary by LifeSmart)
Department of Health and Human Services (HHS)
Visit the HHS website.
Diagnostic Mammogram
DME Medicare Administrative Contractor (MAC)
Drug List
Durable Medical Equipment (DME)
Durable Power of Attorney
(Medicare Glossary by LifeSmart)
E
Election
Employer or Union retiree plans
End Stage Renal Disease (ESRD)
Exception
When applying for an exception, you or the prescriber must get a supporting statement from your doctor.
Excess Charge
Extra Help
F
Formulary
G
Generic Drug
Grievance
If you have an issue about service coverage, prescription or supply, you must file an appeal – refer to the Medicare Glossary; Appeal.
Group Health Plan
Guaranteed issue rights (Medigap Protections)
Guaranteed renewable policy
H
Health care provider
(Medicare Glossary by LifeSmart)
Health Coverage
Health Insurance Marketplace
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
High-deductible Medigap policy
Homebound
Home health agency
Home health care
Hospice
Hospital outpatient setting
Hospital related medical condition
(Medicare Glossary by LifeSmart)
I
Independent reviewer
Initial coverage limit
The donut hole requirement will be phased out in 2020.
In-network
Inpatient care
Inpatient hospital care
Inpatient hospital services
Inpatient prospective payment system (IPPS)
Inpatient rehabilitation facility
(Medicare Glossary from LifeSmart)
L
Large group health plan
Lifetime reserve days
Limiting charge
Living Will
Long-term care
Medicare does not pay for long-term care. You can purchase long-term insurance from private insurance companies.
Long-term care hospital
Services provided include;
- rehabilitation
- therapy
- respiratory
- head trauma treatment
- pain management
Long-term care Ombudsman
An ombudsman is usually a good resource to find information about your rights and protections and local health agencies.
(Medicare Glossary by LifeSmart)
M
Medicaid
(Medicare Glossary by LifeSmart)
Medicaid certified provider
Medicaid office
Medical underwriting
Medicare
Medicare Administrative Contractor (MAC)
Medicare Advantage Plan (Part C)
A Part C plan is a Medicare approved insurance plan from private insurance carriers. Part C provides you with all the benefits of Original Medicare Part A and Part B. Part C includes HMO’s PPO’s etc.
Most Medicare Advantage plans include prescription drug coverage (Part D) and other benefits.
Medicare Advantage Prescription Drug Plan (MA-PD)
Medicare Approved amount
Medicare approved supplier
(Medicare Glossary by LifeSmart)
Medicare certified provider
Medicare Cost Plan
These types of plans are available in some areas.
Medicare Health Maintenance Organization Plan (HMO)
Most HMO’s require you to get a referral from your primary care doctor.
Medicare health plan
Medicare Medical Savings Account Plan (MSA)
Medicare Part A (hospital insurance)
Medicare Part B (medical insurance)
Medicare plan
Medicare Preferred Provider Organization Plan (PPO)
Medicare prescription drug coverage (Part D)
Medicare Prescription Drug Plan (Part D)
Medicare Private Fee-For-Service Plan (PFFS)
Costs may be more or less than in Original Medicare.
Medicare Savings Program
Medicare SELECT
Medicare Special Needs Plan
It is a Medicare Advantage (Part C) type of plan,
Medicare Summary Notice (MSN)
Medigap basic benefits
Medigap Open Enrollment Period
The enrollment period starts in the first month that you are covered under Part B and you are 65 years old or older.
During this enrollment period you cannot be denied a Medigap plan or be charged more due to past or present health conditions.
Enrollment right can vary state-by-state.
Medigap policy
(Medicare Glossary by LifeSmart)
Multi-employer plan
N
Network
When deciding and choosing your plan, it is important to consider the network.
Network pharmacies
Non-preferred pharmacy
(Medicare Glossary by LifeSmart)
O
Occupational therapy
Optional supplement benefits
Original Medicare
- Part A – hospital insurance
- Part B – medical insurance
It is a fee-for-service health plan. Refer to Understanding Your Medicare Choices.
Out-of-network
Out-of-pocket costs
Outpatient hospital care
(Medicare Glossary by LifeSmart)
P
Pap test
Patient lifts
Pelvic exam
Penalty
Pharmacy network
With some Medicare plans, prescriptions will only be covered if they are filled at network pharmacies.
Physical therapy
Podiatrist
Point-of-service-option
Power of Attorney
Like a Living Will, it may be an important document to consider.
Pre-existing condition
Preferred pharmacy
Premium
Preventive Services
Primary care doctor
Prior authorization
Programs of All-inclusive Care for the Elderly (PACE)
PACE combines medical, social, and long-term care services and prescription drug coverage.
Protective sensations
(Medicare Glossary by LifeSmart)
Q
Qualified Disabled and Working Individuals Program (QDWI)
Qualified Individual Program (QI)
Qualified Medicare Beneficiary Program (QMB)
R
Referral
Rehabilitation services
Services could include;
- Physical and occupational therapy
- Psychiatric rehabilitation
- Speech and language pathology
Services can be conducted in an inpatient and/or outpatient setting.
(Medicare Glossary by LifeSmart)
Religious nonmedical health care institution
Respite care
Rural health clinic
S
Screening mammogram
Secondary payer
Service area
Skilled nursing care
Skilled nursing facility care
Specified Low-Income Medicare Beneficiary Program (SLMB)
(Medicare Glossary by LifeSmart)
Speech-language therapy (speech-language pathology services)
State Health Insurance Assistance Program
State Insurance Department
State Medical Assistance office ( for Medicaid)
State Pharmaceutical Assistance Program (SPAP)
State Survey Agency
Step Therapy
Subluxation
Supplemental Security Income (SSI)
(Medicare Glossary by LifeSmart)