Pdf glossary and terms on medicare

The glossary tool provides definitions of terms found on cms. A life insurance policy feature that lets you use some of the policys death benefit prior to death. Enrollment is not aligned when a dual eligible enrolls in medicare and medicaid managed care plans operated by different companies, which is permitted in some. Medicare plans and medicare prescription drug plans pdpspart.

Home health care glossary this glossary is to help our home health care community better understand the terms used in relation to care. It can seem like your health plan is written in a different language. Glossary of terms ehnac glossary of terms 10119 page 2 of 42 term definition aggregator aggregator refers to a web site or computer software that aggregates a specific type of information from multiple online sources. As measured by original medicare, part a and part b, a benefit period begins the first day you enter the hospital or snf and ends when you no longer receive hospital care or skilled care in an snf for 60 days in a row. Glossary of terms and acronyms cobcobc coordination of benefits the coordination of benefits contractor consolidates the activities that support the collection, management, and reporting of other insurance coverage for medicare beneficiaries. Medicare and health insurance terminology balance bill.

Please call to confirm you have the most up to date information about our medicare plans. While it is very helpful, it is not a complete dictionary of medicare or health care terms. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan. Arthroscopy a procedure used to examine the inside of a joint using a viewing tube an.

Blue medicarerx pdp is a prescription drug plan with a medicare contract. Purpose this document defines commonly used terms from the state resource center src and special needs plan snp frequently asked questions faqs. Cms medicare glossary terms related to claim payments. This is also the time you can enroll in the medicare prescription drug benefit part d if you do not enroll during your initial enrollment period you may have to pay a. The following is a list of words and acronyms that are used when discussing medicare, or are important to give you a better understanding of how medicare works. This glossary has many commonly used terms, but isnt a full list. Origin e a beneficiary b l medicare, a efore notice furn that.

It shows the medical services that were provided to you. Some of these terms also definitions of health insurance terms. Medical insurance glossary of terms health medicare pdfs. Center for medicare advocacy glossary of terms center for. The glossary of terms is a list of terms directly or indirectly related to the practice of case management compiled by members of ccmcs exam and research committee erc and based on published literature. This glossary defines many commonly used terms, but isnt a full list. Annual coordinated election period the period of time between november 15 and december 31 of every year when you can change your medicare private drug plan and or your medicare health plan choice for the following year. Common health care terms glossary agency for healthcare research and quality ahrq ahrq is a public health service agency within the u. Medicare glossary help healthcare terms medicare made. Understanding medicare means understanding the meaning of many unfamiliar terms.

A complaint that you communicate to your health insurer or plan. This glossary explains terms in the medicare program. Examples include diabetes, asthma, allergies and hypertension. Cms has a medicare glossary that includes analogous definitions for billed and paid amounts and other payment terms.

A notice given by a health care provider, doctor, or supplier gives to a medicare beneficiary before providing a service or furnishing a product for which medicare. Medicaid, past employer group plan, medicare supplement, etc. Providers that are deemed agree to follow your plans terms and conditions of payment for the services you get. A glossary of english and spanish, and is available as an audio version also. This may be called eligible expense, payment allowance or negotiated rate.

En espanol l medicare part d is full of jargon that you may come across in dealing with your drug plan. Glossary of health coverage and medical terms page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. Pdf portable document format files can be viewed with adobe reader. Reading about medical insurance can sometimes get technical and confusing. Medicare supplement plans allow you to visit any doctor or facility in the united states that accepts medicare, and some provide coverage outside of the usa. Medicare s payment system for inpatient hospitals and facilities. Medicare is the federal health insurance program for people ages 65 and older. Medicare glossary definitions and terminology ehealth medicare. Once out of the coverage gap medicare prescription drug coverage, the beneficiary automatically gets catastrophic coverage. A person designated by social security as entitled to receive medicare. If your provider charges more than the allowed amount, you may have to pay the difference. The terms module, component, and unit are often used.

Medicare preferred provider organization ppo plan a type of medicare advantage plan that offers lower costs if you use the plans network, but allows you to use providers outside of the network for an added cost. Medica glossary of terms information for providers. Some of these terms also might not have exactly the same meaning when. Uniform glossary of health coverage and medical terms. But with this glossary, you can find commonlyused healthcare terms that will come in handy when looking for treatment and coverage options. Benefits beyond those included in medicare part a and medicare part b like prescription drug coverage, are often included. You or your secondary coverage pay the hospital deductible each time you start a new benefit period.

Medicare glossary understand what common medicare terms mean. Medicares annual election period when you can enroll in a plan or change the way you receive coverage. Deductibles may also apply to medicare supplement medigap plans and certain medicare advantage part c plans. Glossary of terms related to dualeligible beneficiaries. Allowed amount the total sum the plan considers reasonable and necessary for a covered service. Medicare part d definition and glossary of terms aarp. Groups of doctors, hospitals, and other health care providers who join together to provide coordinated care to a set of patients and who agree to be held accountable for the quality and total cost of those patients care. In original medicare, a notice that a doctor, supplier, or provider gives a person with medicare before furnishing an item or service if the doctor, supplier, or provider believes that medicare may deny payment.

Medicare supplement plans greatly reduce, or eliminate, deductibles, coinsurance, and copays of medicare approved services that you would normally be responsible to pay. May 26, 2018 medical insurance glossary of terms 2018. Aarp health insurance plans pdf download medicare replacement pdf download. Medicare a nationwide, federally administered health insurance program that covers the costs of hospitalization, medical care, and other services for eligible persons. Use our comprehensive medicare glossary to better understand the definitions of common medicare terms. Jun 25, 2015 glossary of health care terms and acronyms.

This glossary explains terms in the medicare program, but it isnt a legal document. These plans have premiums and are accepted wherever medicare is accepted. Some of these terms also might not have exactly the same meaning when medicare basics. Definitions for billed, allowed and paid amounts and other. You may like excel or pdf file medicare physician fee schedule 2020 english to spanish medical common terms pdf 2019 dot physical wallet card pdf 2019 list of dx code for cpt 93923 pdf home health conditions of participation pdf. These glossary terms and definitions are intended to be educational and may be different from the. When making decisions about health coverage, consumers should know the specific meanings of terms used to.

You pay the same cost for any doctor or hospital, according to the costs listed on your plan benefit summary. Theres a lot to know about medicare, including many terms associated with the insurance program that you. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Many public programs determine eligibility for services according to a persons need for help with adls. Glossary of medicare terms resources medicare solutions. A nationwide, federallyadministered health insurance program that covers the costs of hospitalization, medical care, and some related services for eligible people, usually individuals age 65 and older and disabled individuals under age 65. Medical and billing terminology health medicare pdfs. Words in italics within definitions indicate that theyre explained elsewhere in the glossary. The amount of time during which medicare pays for hospital and skilled nursing facility snf services. Medicare plan glossary of terms medicare advantage plan. A claim is what a doctor submits to us so they can get paid. Medicare can be complex and is full of confusing terms that may not be clear to those with only a basic understanding of this type of insurance.

These glossary terms and definitions are intended to be educational and may be different from the terms. Annual enrollment period the period from october 15 to december 7 when you can enroll in a medicare advantage plan, medicare cost with part d plan, or a standalone prescription drug plan, or switch medicare. Dental, vision and hearing are not covered by original medicare. Glossary of terms and list of abbreviations surgeon generals addiction. Use our glossary of commonly used medicare definitions and terms to get the answers you need. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download medicare supplemental insurance pdf download medicare coverage pdf download. Centers for medicare and medicaid services cob cob close of business cob cob coordination of benefits. Glossary of health coverage and medical terms page 1 of 4 glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. This glossary defines words used by medicare and kelseycare advantage. Some people under age 65 also may be eligible for medicare.

The glossary of terms is an alphabetical list of all terms within the medica provider administrative manual. Medicare has its own vocabulary, so get correct medicare definitions and be an informed enrollee. Artery a large blood vessel that carries blood from the heart to tissues and organs in the body. Glossary of medicare and other health insurance terms. Medicare advantage plans include health maintenance organizations, preferred provider organizations, private feeforservice plans, special needs plans, and medicare medical savings account plans.

The official medicare program provisions are found in the relevant laws, regulations, and rulings. Glossary of medicare terms aarp, may, 2009 comments. The glossary of terms is a list of terms directly or indirectly related to the practice of case management compiled by members of ccmcs exam and research committee erc and based on published literature related to case management. Glossary of terms related to dualeligible beneficiaries of medicare and medicaid accountable care organizations. Glossary of insurance and medical billing terms a accept assignment provider has agreed to accept the insurance company allowed amount as full payment for the covered services. A medicare glossary of terms and descriptions extra help. The period from october 15 to december 7 when you can enroll in a medicare advantage plan or a standalone prescription drug plan, or switch medicare plans. Glossary centers for medicare and medicaid services. Find out the meaning of commonly used medicare terms. Medicare part d federally funded insurance for prescription drugs that is available through private companies as standalone drug coverage or as part of a medicare advantage plan that includes part d. Providers are deemed when they know, before providing services, that you are in a private feeforservice plan, and they agree to give you care.

Medica administrative manual home glossary of terms. This is also the time you can enroll in the medicare prescription drug benefit part d if you do not enroll during your initial enrollment period you. Medicare plan a medical plan other than original medicare, such as medicare health plans or medicare prescription drug plans. Click on a letter to scroll directly to the terms by alphabet and description then click on the term to show the description. Health care services that your health insurance or plan doesnt pay for or cover. In this situation, if you arent given an abn before you get the item or service. A health condition that needs ongoing care and attention. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in. As you explore your medicare choices, you may run across unfamiliar words or phrases. Health care services that help a person keep, learn or.

A federal government website managed and paid for by the u. Glossary of terms terms are listed in alphabetical order cost sharing a provision of the pharmacy benefit that requires you to pay some portion of the cost of the product or service. Glossary scroll breadcrumb left share widget select to show. Medical insurance glossary of terms 2018 health medicare pdfs. Many longterm care insurance policies use the inability to do a certain number of adls such as 2 of 6 as criteria for paying benefits. The letters at the top of the glossary chart will act as alphabetical links. Medicare glossary of terms understanding health care terms. Time period that begins the day youre admitted as an inpatient in a hospital or skilled nursing facility snf. Blue medicarerx value plus pdp and blue medicarerx premier pdp are two medicare prescription drug plans available to service residents of connecticut, massachusetts, rhode island, and vermont.

Medicare glossary of terms inter valley health plan. This is a federal health insurance program for people age 65 or older. It also covers people younger than 65 who have disabilities, plus those with endstage renal disease, requiring dialysis or a kidney transplant, or amyotrophic lateral sclerosis also known as. Ahrqs mission is to support research designed to improve the outcomes. Page 3 of 4 medicare advantage disenrollment period if you enroll in a medicare advantage plan during the annual enrollment period aep from october 15 through december 7.

Below are 10 medicare related words and phrases that are often misinterpreted or misunderstood by medicare beneficiaries. Glossary of commonly used terms glossary draft 1 glossary i. A process where external organizations or accrediting bodies evaluate health care facilities policies, procedures, and. Here are the meanings of words and phrases commonly used in part d, arranged alphabetically. Enrollment in any plan depends on contract renewal. Medicare advantage plans are offered through private companies and must be approved by medicare. If youre enrolled in a medicare advantage plan, medicare services are covered through the plan and arent paid for under original medicare. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Department of health and human services hhs reporting to the hhs secretary. You may also make an appeal if you disagree with a.

Its also known as the aetna medicare plan ppo, which is a medicare advantage plan with an open access feature. A health care place or hospital department where outpatients are given treatment or advice. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. Our helpful medicare glossary contains definitions of common terms. People with medicare can get their health coverage through original medicare, a medicare cost plan, a pace program of allinclusive care for the elderly plan or a medicare advantage plan. Adjudication the final determination of the issues involving settlement of an insurance claim. Appeal an appeal is something you do if you disagree with a decision to deny a request for health care services or prescription drugs or payment for services or drugs you already received. Glossary of medicare and other health insurance terms questions.

If you have questions or comments, call us 7442care or toll free at 18006637146. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Have you ever looked at your medicare plan and wondered what it all means. Accreditation bodies themselves are evaluated and overseen by. Arthritis a disease of the joints characterized by. Annual enrollment period the period from october 15 to december 7 when you can enroll in a medicare advantage plan or a standalone prescription drug plan, or switch medicare plans.

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