[MEDI-CARE-EEZ]™
Open Enrollment Period | Medi-care-eez
Open Enrollment Period"CMS defines the Medicare Advantage Open Enrollment Period as a period from January 1 – March 31 each year. If you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and...
Medicare | Medi-care-eez
Medicare"Per CMS, Medicare provides health insurance coverage to individuals who are age 65 and over, under age 65 with certain disabilities, and individuals of all ages with ESRD. Medicaid provides medical benefits to groups of low-income people, some who may have no...
Explanation of Benefits | Medi-care-eez
Explanation of Benefits"CMS states that each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). This notice gives you a summary of your prescription drug claims and costs." - www.medicare.gov"...is a...
Evidence of Coverage | Medi-care-eez
Evidence of Coverage"CMS explains that if you're in a Medicare plan, your plan will send you an "Evidence of Coverage" (EOC) each year, usually in the fall. The EOC gives you details about what the plan covers, how much you pay, and more." - www.medicare.gov"...is a...
Step Therapy | Medi-care-eez
Step Therapy"CMS defines Step Therapy as a coverage rule used by some Medicare Prescription Drug Plans that requires you to try one or more similar, lower cost drugs to treat your condition before the plan will cover the prescribed drug." - www.medicare.gov"...applies...
Drug Tiers | Medi-care-eez
Drug Tiers"CMS defines Drug Tiers as an option to allow plans the ability to group different drug types together (i.e., Generic, Brand, Preferred Brand). In this regard, tiers could be used to describe drug groups that are based on classes of drugs. If the "tier"...
True Out-of-Pocket | Medi-care-eez
True Out-of-Pocket"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 begin. The drug plan keeps track of...
Catastrophic Level of Coverage | Medi-care-eez
Catastrophic Level of Coverage"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 automatically get "catastrophic coverage." It...
Medicare-Approved Amount | Medi-care-eez
Medicare-Approved Amount"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. Medicare pays part of this amount and...
Medically Necessary | Medi-care-eez
Medically Necessary"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 medical condition, meet the standards...
Preferred Provider Organization | Medi-care-eez
Preferred Provider Organization"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 doctors, hospitals, and providers outside...
Summary of Benefits | Medi-care-eez
Summary of Benefits"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"...for Medicare Advantage Plans and Part D Prescription Drug Plans, this is the list of...
Drug Formulary | Medi-care-eez
Drug Formulary"CMS defines a Drug Formulary as a list of certain drugs and their proper dosages. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary." - www.medicare.gov"...is a list of drugs covered by your drug...
Creditable Prescription Drug Coverage | Medi-care-eez
Creditable Prescription Drug Coverage"CMS defines Creditable Prescription Drug Coverage as prescription drug coverage (for example, from an employer or union) that's expected to pay, on average, at least as much as Medicare's standard prescription drug coverage....
Coverage Gap | Medi-care-eez
Coverage Gap"CMS explains that once you reach the coverage gap, you'll pay no more than 25% of the cost for your plan's covered brand-name prescription drugs. You'll pay this discounted rate if you buy your prescriptions at a pharmacy or order them through the mail....
Medicare Part D | Medi-care-eez
Medicare Part D"CMS defines Medicare Drug Coverage and Plan Part D as Optional benefits for prescription drugs available to all people with Medicare for an additional charge. This coverage is offered by insurance companies and other private companies approved by...
Maximum Out-of-Pocket |Medi-care-eez
Maximum Out-of-Pocket"CMS defines the Maximum Out-of-pocket as the beneficiary's maximum dollar liability amount for a specified period." - www.medicare.gov"...with regards to Medicare Advantage Plans, this is the most amount of money you can expect to spend on copays...
Annual Election Period | Medi-care-eez
Annual Election Period"CMS defines Medicare’s annual Open Enrollment Period (October 15–December 7) as a period to join a plan. During this time each year, you can also drop or switch your plan coverage." - www.medicare.gov"...is for Medicare Advantage and Part D...
Deductible | Medi-care-eez
Deductible"CMS defines a Deductible as the amount you must pay for health care before Medicare begins to pay, either for each benefit period for Part A, or each year for Part B. These amounts can change every year. (See Benefit Period; Medicare Part A; Medicare Part...
Annual Notice of Change | Medi-care-eez
Annual Notice of Change"CMS states and Annual Notice of Change (ANOC) includes any changes in coverage, costs, service area, and more that will be effective starting in January. Your plan sends each Medicare beneficiary a printed copy by September 30." -...
Medicare Savings Program | Medi-care-eez
Medicare Savings Program"CMS says a Medicare Savings Program) is a Medicaid program that helps people with limited income and resources pay some or all of their Medicare premiums, deductibles, and coinsurance." - www.medicare.gov"A Medicaid program that helps people...
Guaranteed Issue Rights | Medi-care-eez
Guaranteed Issue Rights"CMS defines Guaranteed issue rights (also called "Medigap protections") as rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can't...
Medicare Special Needs Plan | Medi-care-eez
Medicare Special Needs Plan"CMS defines Medicare Special Needs Plan (SNP) as a special type of Medicare Advantage Plan (Part C) that provides more focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, who...
Qualified Disabled and Working Individuals Program | Medi-care-eez
Qualified Disabled and Working Individuals Program"CMS defines the Qualified Disabled and Working Individuals (QDWI) Program that helps pay the Part A premium. You may qualify if any of these apply to you: You're a working disabled person under 65 You lost your...
Application Fee | Medi-care-eez
Application FeeWe couldn't find a public definition.... This is a 123Easy Hint! - Hints you learn only from our workshops!"Some Medicare supplement (Medigap plans) have a one-time fee paid to the insurance company to process your application."Schedule a visit Meet...
Medical Savings Account Plan | Medi-care-eez
Medical Savings Account Plan"CMS defines MSA Plans as a combination of a high deductible Medicare Advantage Plan and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs, but...
Qualified Individual Program | Medi-care-eez
Qualified Individual Program"CMS says the QI Program is a state program that helps pay Part B premiums for people who have Part A and limited income and resources. You must apply every year for QI benefits. QI applications are granted on a first-come, first-served...
Medicaid | Medi-care-eez
Medicaid"CMS defines Medicaid as a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare...
Application Summary | Medi-care-eez
Application SummaryWe couldn't find a public definition.... This is a 123Easy Hint! - Hints you learn only from our workshops!"If you apply for Medicare in-person, and would like proof of enrollment, ask for an Application Summary as your receipt.."Schedule a visit...
CMS | Medi-care-eez
CMS"CMS stands for The Centers for Medicare & Medicaid Services and is part of the Department of Health and Human Services (HHS)" - www.medicare.gov"...stands for the Centers for Medicare & Medicaid Services (CMS) which is the branch of the Department of...
Durable Medical Equipment | Medi-care- eez
Durable Medical Equipment"CMS defines Durable Medical Equipment (DME) as Medical equipment that is ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds. DME is paid for under both Medicare Part B and...
Skilled Nursing Facility | Medi-care-eez
Skilled Nursing Facility"CMS defines a Skilled Nursing Facility as a facility (which meets specific regulatory certification requirements) which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or...
Dual Eligible Beneficiary | Medi-care-eez
Dual Eligible Beneficiary"CMS defines Dual Eligible Beneficiaries as persons who are entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid." - www.medicare.gov"...is someone eligible for both Medicare And Medicaid. (Also see Medicare...
Extra Help for Prescription Drugs | Medi-care-eez
Extra Help for Prescription Drugs"CMS defines Extra Help as a Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance." - www.medicare.gov"Programs that lower the cost...
Late Enrollment Penalty | Medi-care-eez
Late Enrollment Penalty"CMS defines a Late Penalty as an amount added to your monthly premium for Part B or a Medicare drug plan (Part D) if you don't join when you're first eligible. You pay this higher amount as long as you have Medicare. There are some exceptions."...
General Election Period | Medi-care-eez
General Election Period"CMS defines the General Enrollment Period (GEP) is January 1 through March 31 of each year. If you enroll in Premium Part A or Part B during the General Enrollment Period, your coverage starts on July 1." - www.medicare.gov"...is a period from...
Specified Low-Income Medicare Beneficiary | Medi-care-eez
Specified Low-Income Medicare Beneficiary"CMS says the SLMB Program is a state program that helps pay Part B premiums for people who have Part A and limited income and resources." - www.medicare.gov"...with regards to Medicare Savings Programs, this state and...
HIPPA | Medi-care-eez
HIPPA"CMS defines HIPPA (The Health Insurance Portability and Accountability Act of 1996 ) as a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or...
Hospice | Medi-care-eez
Hospice"CMS defines Hospice as a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice care is covered under Medicare Part A (Hospital Insurance)." - www.medicare.gov"...is end of life...
Qualified Medicare Beneficiary | Medi-care-eez
Qualified Medicare Beneficiary"CMS says the QMB Program helps pay for: Part A premiums Part B premiums Deductibles, coinsurance, and copayments." - www.medicare.gov"...with regards to Medicare Savings Programs, this state and federally funded program, helps pay Part A...
Health Savings Account | Medi-care-eez
Health Savings Account"Per CMS, to avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least 6 months before you apply for Medicare." - www.medicare.gov"Stop contributing to an HSA 6-months before enrolling in Medicare Part A to...
COBRA | Medi-care-eez
COBRA"The Department of Labor defines COBRA (The Consolidated Omnibus Budget Reconciliation Act ) as a federal law that may let you keep your employer group health plan coverage for a limited time after your employment ends or you lose coverage as a dependent of the...
Medicare Part B | Medi-care-eez
Medicare Part B"CMS defines Medicare Part B as Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that aren't covered by Part A." - www.medicare.gov"...is the second element...
Medicare Part A | Medi-care-eez
Medicare Part A"CMA states that Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care." - www.medicare.gov"...is the first element of Original Medicare. It covers 80% of hospital costs after you...
Medigap | Medi-care-eez
Medigap"CMS defines a Medigap policy / Med Supplement as a supplement insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Except in Massachusetts, Minnesota and Wisconsin, there are 10 standardized plans labeled Plan...
Medical Underwriting | Medi-care-eez
Medical Underwriting"CMS defines Medical Underwriting as the process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, whether or not to add a waiting period for pre-existing conditions (if...
Referral | Medi-care-eez
Referral"CMS defines a Referral as a written OK from your primary care doctor for you to see a specialist or get certain services. In many Medicare Managed Care Plans, you need to get a referral before you can get care from anyone except your primary care doctor. If...
HMO | Medi-care-eez
HMO"CMS defines a Medicare Health Maintenance Organization (HMO) Plan as a type of Medicare managed care plan where a group of doctors, hospitals, and other health care providers agree to give health care to Medicare beneficiaries for a set amount of money from...
Household Discount | Medi-care -eez
Household Discount"Members who live at the same residential address may be eligible for a household discount. Each Medicare eligible adult must have a Blue Cross Medicare Supplement or Legacy Medigap plan and be a permanent resident in the same household. The...
Medicare Beneficiary | Medi-care-eez
Medicare Beneficiary"CMS defines a Beneficiary as the name for a person who has health care insurance through the Medicare or Medicaid program." - www.medicare.gov"...is a person eligible to receive health insurance through Medicare."Schedule a visit Meet with a...
Medicare.gov | Medi-care-eez
Medicare.gov"CMS defines the Medicare.gov site as the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools." - www.medicare.gov"...is the official US government site for Medicare....
Original Medicare | Medi-care-eez
Original Medicare"CMS defines Original Medicare as a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share...
Specialist | Medi-care-eez
Specialist"CMS defines a Specialist as a doctor who treats only certain parts of the body, certain health problems, or certain age groups. For example, some doctors treat only heart problems." - www.medicare.gov"...is a medical professional who is not your primary...
Primary Care Physician | Medi-care-eez
Primary Care Physician"CMS explains that a Primary Care Doctor/Physician is a doctor who is trained to give you basic care. Your primary care doctor is the doctor you see first for most health problems. He or she makes sure that you get the care that you need to keep...
Preventative Services | Medi-care-eez
Preventative Services"CMS defines Preventive Services as Health care to keep you healthy or to prevent illness (for example, Pap tests, pelvic exams, flu shots, and screening mammograms)." - www.medicare.gov"... is a set of Medicare-approved services to prevent...
Telehealth | Medi-care-eez
Telehealth"CMS defines telemedicine or Telehealth as Medical or other health services given to a patient using a communications system (like a computer, phone, or television) by a practitioner in a location different than the patient's." - www.medicare.gov"...is a...
Special Enrollment Period (SEP) | Medi-care-eez
Special Enrollment Period (SEP)"CMS defines a Special Enrollment Period (SEP) as a set time when you can sign up for Medicare Part B if you didn't take Medicare Part B during the Initial Enrollment Period because your or your spouse were working and had group health...
Initial Enrollment Period (IEP) | Medi-care-eez
Initial Enrollment Period (IEP)"CMS defines IEP or The Initial Enrollment Period as the first chance you have to enroll in Medicare Part B. Your Initial Enrollment Period starts three months before you first meet all the eligibility requirements for Medicare and lasts...
Premium | Medi-care-eez
Service Area"CMS defines a Premium as the periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage." - www.medicare.gov"...is the amount of money you pay for your insurance."Schedule a visit Meet with a...
Income Related Monthly Adjusted Amount (IRMAA) | Medi-care-eez
Service Area"CMS explains that if your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago. This is...
Medicare Advantage (Part C) | Medi-care-eez
Medicare Advantage (Part C)"...often called an all-in-one plan. By transferring your Medicare benefits to the plan, the plan administers hospital, medical services, and most often drug benefits." - www.medicare.gov"....often called an all-in-one plan. By transferring...
Service Area | Medi-care-eez
Service Area"CMS defines a Service Area as a geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it’s also generally the area where you can get...
Tricare For Life | Medi-care-eez
Tricare for life (TFL)"TRICARE For Life is defined as a Medicare-wraparound coverage for TRICARE beneficiaries who have Medicare Part A and Medicare Part B, regardless of age or where you live. TRICARE For Life (TFL) provides comprehensive health care coverage....
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