Glossary Terms

The percentage a patient may be required to pay as a share of the cost for services after deductibles.

The fixed amount a patient maybe be required to pay as share of the cost for medical services or supplies (i.e. doctors visits or prescriptions).

Drug coverage received through insurance prior to your eligibility for Medicare that covers as much as Medicare would cover. When you become eligible for Medicare, you may generally keep this coverage.

A small facility that provides inpatient and outpatient services on a limited basis for people in rural areas.

Non-skilled personal care that Medicare does not cover (i.e. bathing, dressing, eating, using the bathroom etc.).

The amount the patient must pay for health care and prescriptions before Original Medicare.

Special projects that usually operate for a limited time in order to test improvements in Medicare coverage, payment, and quality of care.

A Medicare program that helps people with limited income and resources pay premiums, deductibles, and coinsurance.

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.

A hospital that provides an intensive rehabilitation program.

Additional days that Medicare will pay for when the patient is in the hospital for over 90 days. Patients have a total of 60 reserve days that can be used within a lifetime. Medicare covers all costs except for daily coinsurance.

Critical care hospitals that provide treatment for patients staying more than 25 days. Most patients are transferred from the intensive care unit (ICU). Services provided include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management.

The health care needed to diagnose or treat an illness, injury, condition, or disease that meet accepted standards of medicine.

In Original Medicare, this is the amount a doctor or supplier can be paid. Medicare pays part of this amount and the patient is responsible for the difference.

The periodic payment to Medicare, an insurance company, or a health care plan.

Health care to prevent illness or detect illness at an early stage (i.e. mammograms, flu shots, pap tests).

The doctor patients see first for most health problems. In many Medicare Advantage Plans, the patient must see the primary care doctor before seeing any other health care provider.

A written order from a primary care doctor to see a specialist or get specific medical services. In many Health Maintenance Organizations (HMOs), if the patient does not get a referral first, the plan may not pay for the services.

A geographic area where a health insurance plan accepts members if it limits membership based on location.

Skilled nursing care and rehabilitation services provided on a daily basis is a SNF (i.e. physical therapy or injections that can only be given by a registered nurse (RN) or doctor).