GLOSSARY
COMMUNITY MEETING
A GATHERING SPONSORED BY A PRIVATE HEALTH INSURANCE COMPANY TO EXPLAIN MEDICARE OPTIONS AND PROMOTE THEIR COMPANY’S PLANS—USUALLY HELD AT RESTAURANTS
CO-INSURANCE
A % OF A HEALTH CARE PROVIDER’S BILL FOR WHICH YOU ARE LIABLE
CO-PAY
A SET AMOUNT OF A HEALTH CARE PROVIDER’S BILL FOR WHICH YOU ARE LIABLE
DEDUCTIBLE
A SET AMOUNT YOU MUST PAY OUT OF POCKET EACH YEAR BEFORE YOUR INSURANCE BEGINS TO PAY
DOUGHNUT HOLE
A LAPSE IN COVERAGE IN PART D PRESCRIPTION DRUG PLANS INCURRED BETWEEN $2,830 AND $4,550—ALSO KNOWN AS THE “COVERAGE GAP”
DUAL ELIGIBLES
INDIVIDUALS WHO QUALIFY FOR BOTH MEDICARE AND MEDICAID
ENROLLMENT PERIODS
THE TIMES OF THE YEAR WHEN YOU CAN CHANGE PLANS, GENERALLY NOVEMBER 15 TO MARCH 31—ALSO REFERS TO THE TIME RESTRICTIONS AFFECTING THOSE TURNING 65
FORMULARY
LIST OF DRUGS COVERED IN A PARTICULAR PART D PRESCRIPTION DRUG PLAN
GENERIC DRUG
SUBSTITUTE LOW PRICED DRUG FOR A BRAND NAME MEDICATION
MEDICAID
FEDERAL SUBSIDY PLAN FOR LOW INCOME INDIVIDUALS
MEDICARE
FEDERAL HEALTH PLAN FOR U.S. CITIZENS 65 AND OVER PLUS SOME CATEGORIES OF DISABLED INDIVIDUALS THAT ARE OVER 65
MEDICARE ADVANTAGE PLANS
PART C OF THE MEDICARE EQUATION CONSISTING OF PRIVATE INSURANCE PLANS THAT TAKE OVER YOUR HEALTH CARE NEEDS FROM THE FEDERAL GOVERNMENT
MEDICARE AND YOU
THE “BIBLE” OF THE MEDICARE FIELD PUBLISHED ANNUALLY BY THE MEDICARE PROGRAM
MEDICARE SUMMARY NOTICE
QUARTERLY STATEMENT FROM MEDICARE THAT RELATES ALL OF YOUR HEALTH CARE TRANSACTIONS
MEDIGAP/SUPPLEMENTAL INSURANCE
PRIVATE COMPANY HEALTH PLAN OUTSIDE THE MEDICARE UMBRELLA THAT REIMBURSES YOU FOR COVERAGE GAPS IN ORIGINAL MEDICARE
MOOP
MAXIMUM OUT OF POCKET EXPENSE FOR WHICH YOU ARE LIABLE ON AN ANNUAL BASIS
ORIGINAL MEDICARE
SIMPLY REFERS TO THE BASIC MEDICARE COVERAGE
PART A
ORIGINAL MEDICARE HOSPITAL COVERAGE
PART B
ORIGINAL MEDICARE PHYSICIAN, OUTPATIENT, LAB, PREVENTIVE CARE, X-RAYS, AND DURABLE MEDICAL EQUIPMENT COVERAGE
PART C
PRIVATE HEALTH INSURANCE PLANS RELIEVING THE GOVERNMENT OF THEIR MEDICARE OBLIGATION –GENERALLY REFERRED TO AS MEDICARE ADVANTAGE PLANS
PART D
PRESCRIPTION DRUG COVERAGE PROVIDED BY A PRIVATE HEALTH INSURER
PROVIDER NETWORK
LISTING OF HEALTH CARE PROVIDERS THAT PARTICIPATE IN A PARTICULAR HEALTH INSURER’S PLAN
UNDERWRITING
HEALTH QUESTIONS PERTAINING TO PRE-EXISTING CONDITIONS AND THE STATUS OF YOUR GENERAL HEALTH
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