Medicare important terms

1. Medicare: A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
2. Original Medicare: The original fee-for-service program that provides hospital insurance (Part A) and medical insurance (Part B).
3. Part A: The hospital insurance part of Original Medicare that covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
4. Part B: The medical insurance part of Original Medicare that covers doctor visits, preventive services, durable medical equipment, and some home health care.
5. Part C: Medicare Advantage plans that provide all of the coverage under Original Medicare but may also offer additional benefits and different cost-sharing arrangements.
6. Part D: A separate prescription drug coverage program available through private insurance companies.
7. Medicare Supplement Insurance (Medigap): Private insurance that supplements Original Medicare by covering some of the     out-of-pocket costs, such as copayments, coinsurance, and deductibles.
8. Deductible: The amount you must pay for covered services before Medicare begins to pay its share.
9. Coinsurance: Your share of the cost for covered services after you meet your deductible.
10. Copayment: A fixed amount you pay for covered services, such as a doctor visit or prescription drug.
11. Premium: The monthly payment you make to enroll in or maintain coverage under Medicare.
12. End-Stage Renal Disease (ESRD): A permanent kidney failure that requires dialysis or a kidney transplant to sustain life.
13. Skilled Nursing Facility (SNF): A facility that provides inpatient care for people who require skilled nursing or rehabilitation services.
14. Hospice Care: Palliative care for people with a terminal illness, provided in a variety of settings, including the patient's home, a hospice center, or a hospital.
15. Home Health Care: Health care services provided in the patient's home, such as skilled nursing care, physical therapy, and occupational therapy.
16. Durable Medical Equipment (DME): Medical equipment that can withstand repeated use, such as wheelchairs, hospital beds, and oxygen equipment.
17. Preventive Services: Health care services that help prevent illness or detect health problems early, such as flu shots, mammograms, and colorectal cancer screenings.
18. Enrollment Periods: The specific times when you can enroll in or change your Medicare coverage, including the Initial Enrollment Period, Annual Enrollment Period, and Special Enrollment Period.
19. Initial Enrollment Period: The 7-month period when you first become eligible for Medicare, during which you can enroll in Part A and Part B.
20. Annual Enrollment Period: The period from October 15 to December 7 each year during which you can enroll in, change, or disenroll from a Medicare Advantage or Part D plan.
21. Special Enrollment Period: A period outside of the Annual Enrollment Period during which you can enroll in, change, or disenroll from a Medicare Advantage or Part D plan, if you experience a qualifying life event, such as moving out of the plan's service area.
22. Out-of-Pocket Maximum: The maximum amount you must pay out of pocket for covered services in a year under a Medicare Advantage plan.
23. Network: The group of health care providers that have contracted with a Medicare Advantage or Medicare Part

24. Formulary: A list of prescription drugs covered by a Part D plan, which may change from year to year.
25. Prior Authorization: A requirement that you get approval from your health plan before getting certain medical services or prescription drugs.
26. Step Therapy: A requirement that you try a lower-cost drug before your plan will cover a more expensive drug.
27. Coverage Gap: The period during which you are responsible for paying a larger share of the cost for your prescription drugs, before reaching the catastrophic coverage threshold under a Part D plan.
28. Catastrophic Coverage: The portion of the Part D benefit that covers a large portion of the cost for prescription drugs once you reach the annual out-of-pocket spending limit.
29. Extra Help: A federal program that helps low-income Medicare beneficiaries pay for some or all of the cost of their Part D premium, deductible, and coinsurance.
30. Medicare Fraud: The illegal act of submitting false claims to Medicare or using Medicare to obtain items or services that are not medically necessary, with the intent to defraud the program.
31. Medicaid: A joint federal-state program that provides health coverage to low-income individuals and families.
32. Dual Eligible: A person who is eligible for both Medicare and Medicaid.
33. Medicare Savings Programs: Medicaid programs that help pay for some or all of the cost of Medicare for people with limited income and resources.
34. Medicare Part B Premium: The monthly premium for medical insurance under Original Medicare, which is usually deducted from your Social Security check.
35. Medicare Part D Premium: The monthly premium for prescription drug coverage under a Part D plan, which can vary depending on the plan.
36. Out-of-Pocket Limit: The maximum amount you will have to pay out of pocket for covered services in a year under a Medicare Advantage plan.
37. Provider: A health care professional, such as a doctor, nurse, or hospital, that provides covered services under Medicare.
38. Service Area: The geographic area where a Medicare Advantage or Part D plan is available.
39. Open Enrollment: The period from October 15 to December 7 each year during which you can enroll in, change, or disenroll from a Medicare Advantage or Part D plan.
40. Explanation of Benefits (EOB): A statement from Medicare or a Medicare Advantage plan that explains what Medicare or the plan paid for a covered service and what you are responsible for paying.
41. Medicare Supplement (Medigap) Insurance: Private insurance that helps pay for some of the cost-sharing requirements, such as deductibles, copayments, and coinsurance, under Original Medicare.

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