Glossary

B

• Benefit Period

  The period of time that begins when you enter a hospital or skilled nursing facility and ends when you haven’t received any inpatient hospital care or care in a skilled nursing facility for 60 days in a row. You must pay the inpatient hospital deductible for each benefit period and there’s no limit to the number of benefit periods.

C

• Coinsurance

  The percentage of the Medicare-approved payment amount that you have to pay for a medical service. For example, if your coinsurance is 20 percent and Medicare approves a $100 doctor’s office visit, Medicare will pay $80 and you’ll pay $20

• Custodial Care (Non-skilled Care)

  The care that helps you with activities of daily living. It may also include care that most people do for themselves (e.g., diabetes monitoring).

D

• Deductible

  The amount you must pay for health care or prescriptions before Medicare, your prescription drug plan or other health care insurance will begin to pay incurred costs.

• Durable Medical Equipment

  Equipment needed for medical reasons that is sturdy enough to be used many times without wearing out. Examples include wheelchairs, hospital beds and equipment that supplies a person with oxygen.

E

• Excess Charges

  If you’re enrolled in the Original Medicare Plan, this is the difference between a doctor’s or other health care provider’s actual charge (which may be limited by Medicare) and the Medicare-approved payment amount.

G

• Guarantee Issue

  A right you have in certain situations when insurance companies are required by law to sell or offer you a Medicare supplement policy. During these situations, an insurance company cannot deny you a Medicare supplement policy, place conditions on a policy or charge you more for a policy because of past or present health conditions.

• Guaranteed Renewable

  Requires an insurance company to automatically renew or continue your Medicare supplement policy unless there has been a material misrepresentation or fail to pay your premiums on time.

H

• Hospital Insurance (Medicare Part A)

  The part of Medicare that pays for inpatient hospital stays, care in a skilled nursing facility, home health care and hospice care.

L

• Lifetime Reserve Days

  With Medicare Part A, these are the additional days that Medicare will pay for when you’re in a hospital more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.

M

• Medical Insurance (Medicare Part B)

  The part of Medicare that covers doctors’ services, outpatient hospital care and some other services that Medicare Part A doesn’t cover, such as physical and occupational therapy.

• Medical Underwriting

  The process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, to add a waiting period for pre-existing conditions (if your state law allows it) and how much to charge you for that insurance.

• Medically Necessary

  Services or supplies that are needed for the diagnosis or treatment of your medical condition and that meet accepted standards of medical practice.

• Medicare Advantage Plans (Medicare Part C, such as an HMO or PPO)

  Provides your Medicare Parts A and B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Cost for items and services vary by plan.

• Medicare Supplement or Medigap

  Health insurance policies that typically have standardized benefits and are sold by private insurance companies. Medigap policies work in tandem with your Medicare Part A and B coverage. They allow you to use any doctor or hospital that accepts Medicare.

• Medicare-approved Amount

  In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It includes what Medicare pays and any deductible, coinsurance or copayment you pay. It may be less than the doctor or supplier charges.

O

• Open Enrollment

  The best time to buy a Medicare supplement policy is during your Medicare supplement open enrollment period. This period lasts for six months and begins on the first day of the month in which you’re both age 65 or older and enrolled in Medicare Part B. During this period, an insurance company can’t use medical underwriting.

P

• Prescription Drug Plan (Medicare Part D)

  A stand-alone prescription drug plan that adds prescription drug coverage to the Original Medicare Plan and are offered by insurance companies.

• Preventive Care

  Health care that emphasizes prevention, early detection and early treatment of conditions, such as routine women’s exams and immunizations.

S

• Skilled Nursing Facility

  A skilled nursing facility is a facility that provides skilled nursing care and is approved for payment by Medicare, or is qualified to receive such approval if so requested. Custodial care does not qualify as an eligible expense.