True Out-of-Pocket Official Definition: “True out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan out-of-pocket threshold of $$6,550 (for 2021). TrOOP costs determine when a person’s catastrophic coverage will...
Catastrophic Level of Coverage Official Definition: “CMS defines this level as: Once you’ve spent $6,550 out-of-pocket in 2021, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you...
Medicare-Approved Amount Official Definition: “CMS defines Medicare-Approved Amount as in Original Medicare, as the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges....
Medically Necessary Official Definition: “CMS defines Medically Necessary as services or supplies that: are proper and needed for the diagnosis or treatment of your medical condition, are provided for the diagnosis, direct care, and treatment of your...
Preferred Provider Organization Official Definition: “CMS defines a Medicare Preferred Provider Organization (PPO) Plan as a type of Medicare Advantage Plan in which you use doctors, hospitals, and providers that belong to the network. You can use...
Summary of Benefits Official Definition: “Per healthcare.gov Its an easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans.” – www.healthcare.gov [Medi-Care-Eez] Definition:...