Medicare

Medicare Private Fee-for-Service (PFFS) Plan is a type of Medicare Advantage Plan that allows beneficiaries to receive healthcare services from any provider that accepts the plan's payment terms and conditions

Annual Election Period (AEP) is a specified time frame during which individuals who are enrolled in certain types of health insurance plans, such as Medicare Advantage and Medicare Part D, can make changes to their coverage for the upcoming year.

A Disability Accidental Means Provision is a clause in a disability insurance policy that provides benefits if the policyholder becomes disabled due to an accidental injury caused by accidental means.

An Explanation of Medicare Benefits (EOMB) is a statement that is sent to a Medicare beneficiary after a claim for medical services or supplies has been processed by Medicare. It is a summary of the payment decision made by Medicare and the amount the patient is responsible for paying.

Group insurance and Medicare are two different types of insurance that provide health coverage for individuals.

Medicaid is a government-sponsored healthcare program that provides medical assistance to low-income individuals and families who cannot afford to pay for healthcare services. It is jointly funded by the federal and state governments, and eligibility and benefits can vary by state. Here are some key features:

Medicare is a federal health insurance program in the United States that provides coverage to people who are 65 years or older, younger people with certain disabilities, and people with End-Stage Renal Disease (ESRD).

he Medicare Advantage Disenrollment Period (MADP) is a period that allows Medicare Advantage enrollees to disenroll from their plan and return to Original Medicare. The MADP occurs annually from January 1 to March 31, and during this time, Medicare Advantage enrollees can switch to Original Medicare with or without a Part D plan.

The Medicare Advantage Open Enrollment Period (OEP) is a period during which Medicare beneficiaries who are enrolled in a Medicare Advantage Plan can make changes to their coverage. It occurs annually from January 1 to March 31.

Medicare Advantage plans, also known as Medicare Part C, are a type of health insurance plan offered by private insurance companies that provide Medicare benefits to individuals who are eligible for Medicare Part A and Part B. Medicare Advantage plans may offer additional benefits beyond what is covered by Original Medicare, such as prescription drug coverage, dental, vision, and hearing services, wellness programs, and more.

A Medicare Advantage Prescription Drug Plan (MA-PD) is a type of Medicare Advantage plan that offers both medical and prescription drug coverage in a single plan. These plans are offered by private insurance companies that have contracts with Medicare and must provide at least the same level of coverage as Original Medicare.

Medicare Claims Processing refers to the process of reviewing and paying claims submitted by healthcare providers for services rendered to Medicare beneficiaries. This process is carried out by the Centers for Medicare & Medicaid Services (CMS) and its contractors.

Medicare exclusions refer to the healthcare services and items that are not covered by the Medicare program. These exclusions may vary depending on the specific type of Medicare coverage, such as Medicare Part A, Part B, Part C, or Part D.

Medicare HMO (Health Maintenance Organization) Plans are a type of Medicare Advantage Plan that provides health care coverage through a network of providers, such as doctors, hospitals, and other health care facilities, who agree to provide services to plan members at a lower cost. Here are the key features of Medicare HMO Plans:

A Medicare PPO (Preferred Provider Organization) Plan is a type of Medicare Advantage Plan that provides healthcare coverage through a network of healthcare providers. These plans offer more flexibility than HMO (Health Maintenance Organization) plans, but may come with higher out-of-pocket costs.

Medicare Part D is a federal government program that provides prescription drug coverage for Medicare beneficiaries. It is designed to help seniors and people with disabilities afford the cost of their medications.

Medicare SELECT is a type of Medicare Supplement insurance plan, also known as Medigap insurance. Both Medicare SELECT and Medigap policies are designed to help cover out-of-pocket costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles.

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage Plan that provides specialized healthcare services and support to beneficiaries who have specific health conditions, live in certain institutions, or are eligible for both Medicare and Medicaid. SNPs are designed to meet the unique needs of these individuals and provide them with coordinated care.

Medicare assignment refers to an agreement between Medicare and healthcare providers (such as doctors, hospitals, and suppliers) in which the provider agrees to accept the Medicare-approved amount as full payment for covered services or supplies. This means that the provider cannot charge the patient any additional costs beyond the Medicare-approved amount, except for any applicable coinsurance or deductible.

A Medicare-Sponsored Medical Savings Account (MSA) is a type of Medicare Advantage plan that combines a high-deductible health plan with a savings account. It is designed for individuals who are willing to take on more out-of-pocket costs in exchange for lower premiums and the ability to save money tax-free to pay for healthcare expenses.

Medigap, also known as Medicare Supplement insurance, is private health insurance designed to supplement original Medicare. It helps pay for some of the out-of-pocket costs that Medicare does not cover, such as deductibles, copayments, and coinsurance.

Original Medicare is a fee-for-service health insurance program offered by the federal government that provides healthcare coverage to eligible individuals aged 65 or older, people with certain disabilities, and those with end-stage renal disease.

The Part D Coverage Gap, also known as the Donut Hole, is a temporary limit on prescription drug coverage under Medicare Part D. It is a phase of the Part D benefit that starts after you and your plan have spent a certain amount on covered prescription drugs.

Medicare Part D is a prescription drug coverage program offered by private insurance companies that contract with Medicare. Part D Expenses and Plan Limits refers to the amount of money you and your plan pay for prescription drugs, as well as the maximum amount of money your plan will pay for your prescription drugs in a given year.

The Part D Initial Enrollment Period (IEP) is the first opportunity for eligible individuals to enroll in a Medicare Part D prescription drug plan. The IEP is a seven-month period that begins three months before the month of an individual's 65th birthday and ends three months after the month of their 65th birthday.

A Part D Special Enrollment Period (SEP) is a period of time outside of the Part D Initial Enrollment Period when eligible individuals can enroll in, switch, or drop their Medicare Part D prescription drug plan. Here are the key features of the Part D Special Enrollment Period:

"Standardized Medigap Plans" refers to a set of Medicare Supplement Insurance plans that are standardized by the federal government.

Medicare Deductibles and Copayments refer to the out-of-pocket costs that beneficiaries are responsible for paying under the Medicare program.