Medicare
A federal medical expense insurance program for people age 65 and older even if the individual continues to work. (1) Benefits are also available to anyone, regardless of age, who has been entitled to Social Security disability income benefits for 2 years
Actual Charge
The amount a physician or supplier actually bills for a particular service or supply.
Ambulatory Surgical Services
Care that is provided at an ambulatory center. These are surgical services performed at a center that do not require a hospital stay unlike in-patient hospital surgery.
Approved Amount
Amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare.
Assignment
Physician or a medical supplier agrees to accept the Medicare-approved amount as a full payment for the covered services.
Carriers
Organizations that process claims that are submitted by doctors and suppliers under Medicare.
Coinsurance
Portion of Medicare's approved amount that the beneficiary is responsible for paying.
Comprehensive Outpatient Rehabilitation Facility Services
Outpatient services received from a Medicare participating comprehensive outpatient rehabilitation facility.
Deductible
Amount of expense a beneficiary must first incur before Medicare begins payment for covered services.
Durable Medical Equipment
Medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that a doctor prescribes for use in the home.
Excess Charge
The difference between the Medicare-approved amount for a service or supply and the actual charge.
Intermediaries
Organizations that process inpatient and outpatient claims on individuals by hospitals, skilled nursing facilities, home health agencies, hospices and certain other providers of health services.
Limiting Charge
Maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignment.
Nonparticipating
Doctors or suppliers who may choose whether or not to accept assignment on each individual claim.
Outpatient Physical Occupational Therapy and Speech Pathology Services
Medical necessary outpatient physical and occupational therapy or speech pathology services prescribed by a doctor or therapist.
Pap Smear Screening
Provides for a pap smear to screen for cervical cancer once every 2 years.
Partial Hospitalization for Mental Health Treatment
A program of outpatient mental health care.
Participating Doctor or Suppliers
Doctors and suppliers who sign agreements to become Medicare-participating. For example, they have agreed in advance to accept assignment on all Medicare claims.
Peer Review Organizations
Groups of participating doctors and other health care professionals who are paid by the government to review the care given to Medicare patients.
Medicare Part A
Helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. Qualifications of one of the following: (1) Citizen or legal resident of the United States age 65 or over and qualified for Social Sec
Medicare Part B
Pays for doctor's services and a variety of other medical services and supplies that are not covered by hospital insurance. Most of the services needed by people with permanent kidney failure are covered only by medical insurance. Part B is optional and o
Medicare Part C
Also known as Medicare Advantage. Must cover all of the services covered under Original Medicare (Part A and B) except hospice care and some care in qualifying clinical research studies. It may also offer extra coverage, such as vision, hearing, dental, a
Medicare Part D
Optional coverage is provided through private prescription drug plans (PDPs) that contract with Medicare. Beneficiaries must sign up with a plan offering this coverage in their area and must be enrolled in Part A or in Parts A and B. Medicaid recipients a
Medicare Supplement Policies
Also known as Medigap, are policies issued by private insurance companies that are designed to fill some of the gaps in Medicare. May pay some or all of Medicare's deductibles and copayments. (1) Policies are guaranteed renewable. (2) Must include 30-day
Other Options for Individuals with Medicare
(1) Employer Group Health Plans,
and (2) Medicaid.
Employer Group Health Plans
(1) Disabled Employees, (2) Employees with Kidney Failure, and (3) Individuals Age 65 and Older.
Medicaid
A federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care.
Medicare
A federal medical expense insurance program for people age 65 and older even if the individual continues to work. (1) Benefits are also available to anyone, regardless of age, who has been entitled to Social Security disability income benefits for 2 years
Actual Charge
The amount a physician or supplier actually bills for a particular service or supply.
Ambulatory Surgical Services
Care that is provided at an ambulatory center. These are surgical services performed at a center that do not require a hospital stay unlike in-patient hospital surgery.
Approved Amount
Amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare.
Assignment
Physician or a medical supplier agrees to accept the Medicare-approved amount as a full payment for the covered services.
Carriers
Organizations that process claims that are submitted by doctors and suppliers under Medicare.
Coinsurance
Portion of Medicare's approved amount that the beneficiary is responsible for paying.
Comprehensive Outpatient Rehabilitation Facility Services
Outpatient services received from a Medicare participating comprehensive outpatient rehabilitation facility.
Deductible
Amount of expense a beneficiary must first incur before Medicare begins payment for covered services.
Durable Medical Equipment
Medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that a doctor prescribes for use in the home.
Excess Charge
The difference between the Medicare-approved amount for a service or supply and the actual charge.
Intermediaries
Organizations that process inpatient and outpatient claims on individuals by hospitals, skilled nursing facilities, home health agencies, hospices and certain other providers of health services.
Limiting Charge
Maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignment.
Nonparticipating
Doctors or suppliers who may choose whether or not to accept assignment on each individual claim.
Outpatient Physical Occupational Therapy and Speech Pathology Services
Medical necessary outpatient physical and occupational therapy or speech pathology services prescribed by a doctor or therapist.
Pap Smear Screening
Provides for a pap smear to screen for cervical cancer once every 2 years.
Partial Hospitalization for Mental Health Treatment
A program of outpatient mental health care.
Participating Doctor or Suppliers
Doctors and suppliers who sign agreements to become Medicare-participating. For example, they have agreed in advance to accept assignment on all Medicare claims.
Peer Review Organizations
Groups of participating doctors and other health care professionals who are paid by the government to review the care given to Medicare patients.
Medicare Part A
Helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. Qualifications of one of the following: (1) Citizen or legal resident of the United States age 65 or over and qualified for Social Sec
Medicare Part B
Pays for doctor's services and a variety of other medical services and supplies that are not covered by hospital insurance. Most of the services needed by people with permanent kidney failure are covered only by medical insurance. Part B is optional and o
Medicare Part C
Also known as Medicare Advantage. Must cover all of the services covered under Original Medicare (Part A and B) except hospice care and some care in qualifying clinical research studies. It may also offer extra coverage, such as vision, hearing, dental, a
Medicare Part D
Optional coverage is provided through private prescription drug plans (PDPs) that contract with Medicare. Beneficiaries must sign up with a plan offering this coverage in their area and must be enrolled in Part A or in Parts A and B. Medicaid recipients a
Medicare Supplement Policies
Also known as Medigap, are policies issued by private insurance companies that are designed to fill some of the gaps in Medicare. May pay some or all of Medicare's deductibles and copayments. (1) Policies are guaranteed renewable. (2) Must include 30-day
Other Options for Individuals with Medicare
(1) Employer Group Health Plans,
and (2) Medicaid.
Employer Group Health Plans
(1) Disabled Employees, (2) Employees with Kidney Failure, and (3) Individuals Age 65 and Older.
Medicaid
A federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care.