Glossary of terms

A

Ambulance services

Medically necessary ambulance services.
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At-home recovery

Coverage for at-home recovery paying up to $1,600 per year for short-term, at-home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.
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B

Basic benefits

Basic benefits include both Medicare-covered benefits (except hospice services) and additional benefits.
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C

Catastrophic coverage

After your yearly out-of-pocket prescription drug costs (including copays, coinsurance and 100% drug payments) reach $4,550.
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Cost Plan

Medicare Cost plans are offered by private insurance companies that contract with Medicare to provide you with health care coverage in addition to your Original Medicare benefits. If enrolled in a Medicare Cost plan, you retain your Original Medicare benefits, and the health plan provides additional benefit coverage through their contracted provider network.
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Coverage start date

This is the date from which you are covered for the services outlined in your plan.
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Coverage in the gap

The gap in Medicare Part D coverage when you have between $2,830 and $4,550 in total drug costs in a year.
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Chiropractic services

Manual manipulation of the spine to correct subluxation, provided by chiropractors or other qualified providers.
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D

Dental

Oral Exams, cleanings, dental X-rays.
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Dental services

Oral Exams, cleanings, dental X-rays.
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Deductible

The amount an individual is responsible to pay prior to the Medicare plan covering claims.
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Diabetes self-monitoring training and supplies

Includes coverage for glucose monitors, test strips, lancets, screening tests and self-management training.
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Doctor office visit

Services that are prescribed by a doctor and often administered in a provider's office.
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Doctor and hospital choice

A doctor, hospital, or other health care provider that agrees to accept the plan's terms and conditions related to payment and that meets other requirements for coverage
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Durable medical equipment

Certain medical equipment that is ordered by a doctor for use in the home. Examples are walkers, wheelchairs, or hospital beds. DME is paid for under both Medicare Part B and Part A for home health services.
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E

Enrollment period

The enrollment period for all Medicare plans, except Medigap plans, is Nov 15 through Dec 31st each year. Medigap plans can be purchased at any point during the year.
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Emergency care

You can go to any emergency room if you reasonably believe you need emergency care.
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F

Foreign travel emergency

80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
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G

Gap coverage

The gap in Medicare Part D coverage when you have between $2,830 and $4,550 in total drug costs in a year.
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H

Hearing services

Hearing aids, exam, test, and fitting evaluations.
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Home health care

Services covered by Medicare that include: part-time or periodic skilled nursing care; home health aide services; physical therapy; occupational therapy; speech-language therapy; medical social services; durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers); medical supplies; and other services.
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Hospice

Services covered by Medicare Part A for individuals with a terminal illness. Services may include prescriptions for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in an individual’s home; however, Medicare may cover some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).
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I

Immunizations

Flu vaccine, Hepatitis B vaccine, Pneumonia vaccine.
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Initial coverage

The amount of drug costs covered until the coverage gap.
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Inpatient hospital care

Services covered by Medicare Part A that include a semiprivate room, meals, general nursing, and other hospital services and supplies.
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Inpatient mental health care

Includes medically necessary intermittent skilled nursing care, home health aide services, and rehabilitation services, etc.
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L

Link to formulary

A formulary is a list of drugs that a health plan covers.
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Link to in-network pharmacies

A list of in-network pharmacies.
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M

Medicare Advantage plans

Medicare Advantage plans are health plan options that are part of the U.S. Government's Medicare program. They usually cover all of your Medicare-eligible health care. This coverage can--but doesn't always--include prescription drug coverage.
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Medicare prescription drug plan

Medicare prescription drug plans can be added to other Medicare and/or Medigap plans to cover prescription expenses. These plans are offered by private insurance companies approved by Medicare.
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Medicare Supplement plan

A Medicare supplement policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare plan coverage. Medicare supplement policies help pay some of the health care costs that the Original Medicare plan doesn’t cover. If you are in the Original Medicare plan and have a Medicare Supplement policy, then Medicare and your Medicare Supplement policy will pay both their shares of covered health care costs.
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O

One month supply of non-preferred drugs

Drugs that are not on a plan-approved drug list.
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One month supply of specialty drugs

Specialty and non self-administered injectables.
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Outpatient mental health

Programs that provide diagnostic and treatment services for individuals whose psychiatric problems or other emotional difficulties are not severe enough to require twenty-four hour care but who can benefit from regular consultation and therapy with a mental health professional.
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Outpatient rehabilitation services

Occupational Therapy, Physical Therapy, Speech and Language Therapy.
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Outpatient services and surgery

Medicare covered visits to an outpatient hospital facility or ambulatory surgical center.
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Outpatient substance abuse care

Treatment for alcoholism and drug abuse on an ambulatory basis in the outpatient department of a hospital or in a clinic or other medical facility, including a physician’s or other health practitioner’s office.
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P

Part A deductible

Covers the Medicare Part A (Hospital services) deductible for that year.
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Part B deductible

Covers the Medicare Part B (Doctor services) deductible for that year.
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Part B excess

This is the difference between a doctor's or other health care provider's actual charge (which may be limited by Medicare or the state) and the amount Medicare will reimburse.
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Physical exams

One time physical exam.
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Podiatry services

Medically necessary foot care, including care for medical conditions affecting the lower limbs.
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Prescription drugs

Drugs covered under Medicare Part B and Part D.
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Prescription drug coverage

Identifies whether the plan covers prescription drugs. If the plan does not cover prescription drugs you may want to consider adding a Part D Prescription drug plan.
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Premium and other important information

A regularly scheduled payment to an insurer or health care plan.
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Preventive care NOT covered by Medicare

The preventive medical care benefit pays up to $120 per year for such things as a physical examination, serum cholesterol screening, hearing test, diabetes screenings and thyroid function test.
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Prosthetic devices

Includes braces, artificial limbs and eyes, etc.
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S

Skilled nursing

A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.
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Skilled nursing facility

Services that include a semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies. Medicare covers skilled nursing facility care after the individual has been in the hospital for 3 days.
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Skilled nursing facility co-insurance

A nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.
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T

Three month supply of non-preferred brand drugs

Drugs that are not on a plan-approved drug list.
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Three month supply of specialty drugs

Specialty and non self-administered injectables.
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U

Urgently needed care

This is NOT emergency care.
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V

Vision

Medicare covered eye exams and glasses.
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Vision services

Medicare covered eye exams and glasses.
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Glossary of terms