Saturday, May 25, 2013

Definitions Of The Most Common Medicare Terms

By B. Loughead

There are a number of Medicare terms that everyone should know if they are policy holders or are about to be. We have listed the more common ones below.


Appeal - a formal complaint that an individual files if certain drugs and services are not covered by their particular Medicare plan when they feel that they should be.

Co-pay - the portion of any medical services and/or prescription medications that you are responsible for paying.

Deductible - the amount of money that must be paid by the insured for medical care before Medicare covers any such expenses.

Doughnut hole - the coverage gap found in some Medicare drug plans (scheduled to close in 2020).

Dual eligibility - refers to being eligible for both Medicaid and Medicare.

Enrollment period - the limited time period that an individual can enroll in a health care plan or switch to a different one.

Grievance - a formal complaint made to Medicare when your health care plan or the person administering medical treatment to you has treated you improperly or poorly.

Home health care - short-term care provided while you are recovering at home from an illness or injury. Occasional part-time skilled care as well as some medical equipment, services, and supplies are included in a home health care plan.

Hospice care - care administered to those individuals with a terminal illness or medical condition (covered in Part A). Counseling and physical care are included.

Long-term care - Medicare does not cover ongoing health or personal care that an assisted living facility or a nursing home would provide.

Medicaid - federal and state programs that are separate from Medicare. This assists those individuals with limited assets and low incomes to pay for their medical expenses.

Medicare Advantage - alternative health care for Parts A and B that are provided by a private insurance carrier.

Medicare Part A - pays for hospice care, hospital stays, and some home health care.

Medicare Part B - pays for lab tests, medical equipment, physician visits, and some medical services.

Medicare Part D - coverage that is provided for some brand name and generic medications.

Medigap - private insurance that covers the gaps in Part A and Part B coverages. It is also sometimes referred to as Medicare Supplement Insurance.

Out-of-pocket expenses - those expenses that you are responsible for and are not covered by Medicare insurance.

Premiums - payments for health care coverage that is usually made on a monthly basis.
Skilled nursing care - medical care provided by licensed LPN's (Licensed Practical Nurses) or RN's (Registered Nurses).

For more information, the entire Medicare glossary is available online at the US Government Site for Medicare or you can click Medicare supplement information.

Summit Medigap is an independent insurance agency that specializes in Medicare supplement insurance. We make Medicare seem easy™. For more information about Medicare supplement insurance visit http://www.SummitMedigap.com/ or call us at 1-888-40-Summit (888-407-8664). We have helped many people in Florida, Georgia, North Carolina, South Carolina, Texas, Colorado and Michigan to name a few.

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