|PACE (Programs of All-inclusive Care for the Elderly)||
PACE combines medical, social, and long-term care services for frail people who live and get health care in the community. They are a joint Medicare and Medicaid option in some states. To be eligible, you must:
The goal of PACE is to help people stay independent and live in their community as long as possible, while getting high quality care they need.
|Part A (Hospital Insurance)||
The part of Medicare that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
|Part B (Medical Insurance)||
Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that aren't covered by Part A.
|Partial Subsidy Eligible||
You get a partial amount of extra help.
|Plan members who qualify for extra help||
These plan members qualify to get extra help from Medicare paying their prescription drug coverage costs. This extra help is also known as the "Low-Income Subsidy." People who qualify for this program get help paying their Medicare plan's monthly premiums, annual deductible, and prescription co-payments.
The name of the plan offered by the company that contracts with Medicare.
|Point of Service (POS)||
An HMO option that lets you use doctors and hospitals outside the plan for an additional cost.
A health problem you had before the date that a new insurance policy starts.
A network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy.
|Preferred Provider Organization (PPO)||
A type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
The periodic payment to Medicare, an insurance company, a health care plan, or a drug plan for health care or prescription drug coverage.
Insurance companies set their own premiums for Medigap (Medicare Supplement Insurance) policies. How they set the price affects how much you pay now and in the future. Medigap policies can be prices or "rated" in three ways:
Prior authorization means that you will need prior approval from an insurance plan before you fill your prescription. If a drug has prior authorization, you will need to work with the plan and your doctor to obtain an exception. For prior authorization information, you can access the plan's website to identify the specific requirements for that plan. Many prior authorization requirements can be resolved at the point of sale and do not require any additional information from your physician. Knowing what the prior authorizations are before going to your doctor's office may save you time at the pharmacy counter.
|Private Fee-for-Service Plan||
A type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits Original Medicare doesn't cover.
*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations,and rulings.