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Glossary

Common terms related to Medicare Supplement Insurance.
    • Annual Election Period (AEP)
    • Period from October 15 through December 7 during which you can sign up for, change, or
      disenroll from a Medicare Advantage plan.
    • Assignment
    • This is an agreement by your doctor or other supplier that they'll be paid directly by Medicare. They agree to accept the payment amount Medicare approves for the service. They also agree not to bill you for any more than the Medicare deductible and coinsurance.
    • Benefits
    • The health care services and expenses a health plan covers.
    • Benefit Period
    • The period of time when you are admitted and treated in a hospital or skilled nursing facility. This period starts the day you enter a hospital or skilled nursing facility. It ends when you haven't received any hospital or skilled nursing facility care for 60 days in a row.
    • Coinsurance
    • The percentage of the Medicare-approved amount that you have to pay for covered health care services and/or prescription drugs. For example, the health plan may cover 80 percent, and you're required to pay 20 percent. Some plans have you first pay the deductible. Then, you pay the plan copayment or coinsurance for covered health care services
    • Copayment
    • A fixed fee amount that subscribers to a medical plan must pay when using specific services that an insurance plan covers.
    • Cost-Sharing
    • A term for costs that members must pay. The most common types of cost sharing are deductibles, copays and coinsurance.
    • Deductible
    • Amount that you must pay for Medicare-approved expenses before Original Medicare begins to pay.
    • *Plan N requires $20 copayment for office visits; $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible.
    • Election Period
    • A certain period of time when you can join a Medicare health plan if it is open and accepting new Medicare members. If a health plan is open, it must allow all eligible people with Medicare to join.
    • Excess Charge
    • The difference between what a health care provider can charge and the Medicare-approved amount.
    • Guaranteed Issue Rights (also called "Medigap Protections")
    • Rights you have in certain situations when the law requires insurance companies to sell or offer you a Medicare Supplement insurance policy. In these cases, an insurance company: Can't deny you a Medicare Supplement policy, Place conditions on a policy, such as exclusions for pre-existing conditions, Can't charge you more for the policy because of a past of present health problem.
    • Guaranteed Renewable Policy
    • An insurance company can't end the policy, unless you: Make false statements, Commit fraud, Don't pay your premiums. All Medicare Supplement insurance policies issued since 1992 are guaranteed renewable.
    • Hospice Care
    • A care and support program for someone who is terminally ill. This care helps him/her live out the time left to the fullest extent possible.
    • *Plan N requires $20 copayment for office visits; $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible.
    • Medicaid
    • A joint federal and state program. It helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state. Most healthcare costs are covered if you qualify for both Medicare and Medicaid.
    • Medicare Part A
    • Part of Original Medicare. It helps cover some, but not all, of the expenses you may have for inpatient hospital care. Or, for medical care that you may receive at a skilled nursing facility (not a custodial care facility). It also covers some hospice care and some home health care. Limitations apply, and you will have deductibles, copays or other costs to meet.
    • Medicare Part B
    • Part of Original Medicare. This helps cover medically necessary services from doctors or outpatient hospital care. It also helps with costs associated with some physical and occupational therapist services, some home health care services, emergency and preventive care. You typically must sign up for Part B. Then, pay a monthly premium in order to get benefits.
    • Medicare Part C
    • Another way to get Medicare Coverage.  The Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage is provided through the Medicare Advantage Plan, not Original Medicare.  Medicare Advantage Plans are offered by private companies approved by Medicare.  There are different types of Medicare Advantage Plans.
    • Medicare Part D
    • The optional Medicare prescription drug coverage that helps with your prescription drug costs. This coverage is available as a standalone Medicare Prescription Drug plan (PDP). Or, as part of a Medicare Advantage plan (MAPD).
    • Medicare-Approved Amount
    • In Original Medicare, the amount that a physician who accepts assignment, can be paid. It includes what Medicare pays and any other deductibles, coinsurance or copayments.
    • Medical Underwriting
    • This is based on your medical history. It's the process that an insurance company uses to decide whether or not to: Accept your application for insurance, Add a waiting period for pre-existing conditions (if your state law allows it). They also decide how much to charge you for that insurance.
    • Medicare Advantage Plan (Part C)
    • Another way to get Medicare Coverage. The Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage is provided through the Medicare Advantage Plan, not Original Medicare. Medicare Advantage Plans are offered by private companies approved by Medicare. There are different types of Medicare Advantage Plans.
    • Medicare Prescription Drug Plan (Part D)
    • A standalone drug plan that adds prescription drug coverage to: Original Medicare, Some Medicare Costs plans, Some Medicare Private-Fee-for-Service plans, MedicareMedical Savings Account plans. If you have a Medicare Supplement insurance policy without prescription drug coverage, you can also add a Medicare Prescription Drug Plan. Insurance companies and other private companies that Medicare approves offer these plans. Medicare Advantage Plans can also offer prescription drug coverage. This follows the same rules as Medicare Prescription Drug Plans.
    • Medicare Supplement Insurance Plan
    • Insurance policy that private companies offer. It helps pay for select benefits that Original Medicare (Parts A and B) doesn’t cover. New Medicare Supplement insurance policies haven’t covered prescription drugs since 2006. This is when Part D plans were introduced.
    • Medicare SELECT
    • A type of Medicare Supplement insurance policy that may require you to select a hospital. In some cases, you have to use in-network doctors to get full benefits.
    • Open Enrollment Period (Medigap)
    • A six-month period (one‑time-only). This is when federal law allows you to buy any Medicare Supplement insurance policy you want that’s sold in your state. It starts the first month that you’re covered under both Medicare Part B, and you’re 65 or older. During this period, the insurance company cannot deny you a Medicare Supplement insurance policy or charged more due to past or present health problems. Some states may have more open enrollment rights under state law.
    • Out-Of-Pocket Costs
    • Costs such as deductibles, coinsurance and copayments that health plan members pay for covered health care services.
    • Original Medicare
    • Original Medicare is fee-for-service coverage. The government pays your health care providers directly for your Part A and/or Part B benefits under this plan.
    • Pre-Existing Condition
    • A health problem you had before the date that a new insurance policy starts.
    • Plan Premium
    • The monthly cost you pay for your health plan. This cost is in addition to any deductibles, coinsurance or copayments that your plan requires for covered health care services or prescription drugs. You must also keep paying your monthly Medicare Part B premium and Part A premium (if applicable).
    • PPO
    • A Preferred Provider Organization gives you access to a network of doctors and hospitals that coordinate your care. This helps you get more benefits than Original Medicare and many Medicare supplement insurance plans. With PPOs, you can use any doctor or hospital outside of the network. But, you’ll generally have a higher copay or coinsurance than if you used in-network providers.
    • Premium
    • A fixed monthly amount you pay for a medical or Prescription Drug Plan.
    • Prescription Drug Plan (PDP)
    • Standalone Medicare Prescription Drug Plans that private companies offer. The federal government approves these plans. The plans offer insurance protection for the costs of prescription medications.
    • Primary Care Physician (PCP)
    • A doctor (usually family practice or internal medicine) who coordinates your health care needs. HMO plans require you to choose a PCP.
    • Prior Authorization (for prescription drug coverage)
    • Process under which certain drugs require approval before members can get them as a covered benefit. The prior authorization program is based on current medical findings, manufacturer labeling information, and Food and Drug Administration guidelines. It applies to medications that are more likely than others to be: Taken incorrectly, Used inappropriately, Taken in amounts that are above the recommendations for dosage or length of treatment.
    • Private Fee-For-Service (PFFS)
    • Private insurance companies offer these Medicare Advantage plans through a contract with the federal government. They include a plan premium for medical coverage.
    • *Plan N requires $20 copayment for office visits; $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible.
    • State Health Insurance Assistance Program (SHIP)
    • A state program that gets money from the federal government. It gives free, local health insurance counseling to people with Medicare.
    • State Insurance Department
    • A state agency that regulates insurance. It gives information about Medicare Supplement insurance policies and other private health insurance.
    • Special Needs Plan (SNP)
    • A Medicare Advantage HMO or PPO plan that is designed to meet the needs of a subset of Medicare beneficiaries. There are three types of SNPs: Dual eligible (with both Medicare and state Medicaid), Institutional (for people living in a long-term care facility), Chronic conditions and disabilities.
    • *Plan N requires $20 copayment for office visits; $50 copayment for emergency room visits. Copayments do not count toward the annual Part B deductible.
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