Medicare Definitions

 


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Medicare Definitions You Should Know Regarding Your Coverage
When you are introduced to the aspects of Medicare there is terminology you may not be aware of.  It is important to understand what Medicare definitions mean to ensure you make the best choice regarding your care. While there are more definitions you will be introduced to as a beneficiary, the following are a few you may see early on during enrollment and outlined in your plan of choice.

Appeal: when you disagree with actions that occurred within your plan or costs you may be left to pay, you can appeal the action.  This includes submitting a request to the appropriate party for further review.

Beneficiary: this is the person who received coverage for services under Medicare or other related program.

Benefit Period: this is a time period or duration in which services provided can be covered by Medicare. For instance, your plan may outline the number of days your plan will cover if you are in the hospital or receiving inpatient care. The benefit period starts on the first day you are admitted for services or treatment.

Coinsurance: this is one of few Medicare definitions people get mixed up with other associated costs of Medicare.  This is a payment made when you share costs related to services with a deductible.  In many cases this amounts to 20 percent before Medicare covers any costs.

Copayment: a shared amount you are required to pay as part of your insurance coverage.  This is something paid at the time of service such as a doctor’s visit or when you pick up a prescription.

Deductible: this is the total amount you are required to pay before Medicare covers costs.  The same can be same is true for prescription drug coverage; this is the cost you pay before your drug coverage pays for medicines.

HHS or Department of Health and Human Services: this is one of few important Medicare definitions to know.  This is a federal agency that oversees health programs offered to Americans including Medicare, Medicaid, and more. You can get information about Medicare coverage, ways to get help paying costs, and other related needs for children and adults.

Durable Medical Equipment: this refers to medical equipment ordered by your healthcare provide that is used in your home such as a wheelchair, hospital bed or walker.

Durable Power of Attorney: this document allows someone you know to make healthcare decisions on your behalf.  It is a helpful legal document used when a beneficiary is not able to make their own decisions about their health.

Formulary: list of drug medications covered under the prescription drug plan, also known as Medicare Part D. This is also known as a drug list.

HIPAA or Health Insurance Portability and Accountability Act of 1996: this is also known as privacy rule.  This is a regulation that keeps personal and health information private while promoting and protecting quality health of the general public.

Medigap: known as Medicare supplement insurance it helps cover “gaps” or costs Medicare plans do not cover.

Penalty: this is added to your monthly premium when you do not enroll for Medicare coverage during the enrollment period or when you become eligible. Some exceptions may apply.

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