Assignment

Health care providers who accept Medicare patients on assignments cannot charge more than the Medicare-approved amount.

Benefit Period

This is the way Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the moment you’re admitted as an inpatient in a hospital or SNF. It ends when you haven’t received any inpatient hospital care or skilled care in a SNF for 60 days in a row. 

A new benefit period begins if you go into a hospital or SNF after one benefit period has ended. You must pay the Part A deductible for each benefit period. There’s no limit to the number of benefit periods.

Coinsurance

Refers to the percentage of the cost that you are required to pay. It is the amount that you share as payment of a medical service or item covered by Medicare. The Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible).

Coordination of Benefits

A system that ensures that your medical bills are sent to the right insurers in case you have more than one.  It decides which one of your multiple health coverages (also called as the payers) will pay first. Your “primary payer” pays what it owes on your bills first and then sends the rest of your bills to the secondary payer.

Copayment (or Copay)

It is the specific or set amount in dollars that you will pay as a pre-set, fixed amount for each service towards the cost of a medical service or item that Medicare covers.

Creditable Coverage

A health coverage under other source or health benefit plans such as employer-sponsored benefits that meet a minimum set of qualifications or at least equal to Medicare.

Deductible

Any amount of out-of-pocket, pre-set, fixed amount payment before Medicare begins to pay for Medicare-approved expenses.

Dual Eligible

The person who can obtain benefits from both Medicare and Medicaid benefits.

Guaranteed Renewable

Medicare supplement plans cannot be terminated by the insurance company unless you make false statements (material misrepresentation) to the insurance company, or don’t pay your premiums on time. Rates are subject to change. Any change will apply to all members of the same class insured under your plan who reside in your state.

Lifetime Reserve Days

Medicare offers an additional 60 days that you can get or withdraw to get a Medicare coverage beyond the 90 days a hospital per benefit period. These 60 days good for a lifetime but are not necessarily needed to use it all in one hospital stay.

Medicare Part A hospital insurance

Part A offers hospital insurance benefits and is the first half of Original Medicare. It covers inpatient hospital stays, hospice care, and skilled nursing facility care.

You can actually encounter multiple Part A benefit periods in the same calendar year if you’re hospitalized more than once, and each benefit period requires you to meet the Part A deductible.

If you are admitted for inpatient hospital care, you don’t have to pay Medicare Part A coinsurance for your first 60 days of your stay. However, you may face coinsurance costs for longer stays.

Medicare Part B medical insurance

Part B offers medical insurance benefits and is the second half of Original Medicare. It covers outpatient hospital care, preventative care, doctors’ services, and other services.

You must have Part B to qualify for Medicare add-ons such as Medicare Supplement Insurance (Medigap) and Medicare Advantage.

Medicare Part C (Medicare Advantage)

Part C is insurance that covers the same things as Original Medicare, but it is provided by private companies and usually includes additional benefits, such as prescription drug coverage, vision, dental, and wellness programs

Medicare Part D prescription drug coverage

Part D is the Prescription Drug Coverage portion of Medicare. The plans are offered by private insurers and not the federal government. It is an optional add-on. The prescription drugs covered and the costs of Part D plans will vary based on the insurance provider.

Medicare Supplement Plan F

Pays 100% of the costs that Medicare would normally bill to you. This means that when you have Medicare supplement Plan F, you will not pay any deductibles. You will pay no copays. Plan F will pay ALL of your share. 

Medicare Supplement Plan G

Functions exactly like Plan F, except for the Part B deductible.  You agree to pay the Part B deductible each year, and after that, it pays everything else.  

Medicare Supplement Plan N

Medicare Supplement Plan N is one of the newer Medigap plans and will usually have lower premiums than Plan F or Plan G.  You will do more cost-sharing along the way. You will pay a doctor copay up to $20 each time you see a doctor and copays of up to $50 for an E.R. visit will be owed by you.

You will also pay excess charges. Some doctors charge an extra 15% above Medicare’s rate, on this plan, you pay the excess charge yourself.

Modified adjusted gross income

This is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have.

Open Enrollment Period

The first day of the month that you are both 65 years old and are enrolled in Medicare Part B and will last for only six months. This is the time that you can apply for Medigap policies that insurance companies cannot decline your application.

Pre-existing Conditions

Are medical conditions that you already have before your Medicare supplement started.

Premium

A fixed amount you have to pay for an insurance plan; usually as a monthly payment.

Premium Penalty

These may apply to Medicare Parts A and B if you don’t enroll when you’re first eligible, unless you qualify for a Special Enrollment Period.

Primary Insurer

The insurance that pays your medical bills first in case you have more than one type of health coverage.

Provider

A person or organization that provides medical services and products, such as a doctor, hospital, pharmacy, laboratory or outpatient clinic.

Standardized

The basic benefits that make up each Medicare supplement plan. The plans, categorized by letters such as F and N, are standardized from company to company.

Service Area

The area, place or location where you need to live to get the benefits of your coverage.