Common Medicare Terms and there Definitions

by Jayson Cohen, American Legacy Solutions

As our healthcare landscape continues to broaden and change so do the terms that services are referred to as. As we know that none of us were born speaking insurance, we have identified some main questions we have gotten over the years and included the definitions* for your benefit below.

Critical Access Hospital (CAH) – A small facility that provides outpatient services, as well as inpatient services on a limited basis, to people in rural areas.

Deductible – The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Medicare Advantage Plan (Part C) – A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you are enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer Prescription Drug Coverage.

Medicare-approved amount – In Original Medicare, this is 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 you’re responsible for the difference.

Medicare Summary Notice – A notice you get after the doctor, other health care provider, or supplier files a claim for Part A or Part B services in Original Medicare. It explains what the doctor, other health care provider, or supplier billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay.

Original Medicare – Original Medicare is 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 (coinsurance and deductibles).

As we know there are many terms used on a regular basis that were not covered in this article please feel free to email us and let us know what other terms or questions that are needed to be addressed. Please check back regularly as we will be addressing different questions and concerns in this section.

*All definitions are taken from CMS product number 11021, revised march 2016

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