Health Care Choices For Minnesotans On Medicare - Metropolitan ...

A publication of the Minnesota Board on Aging Senior LinkAge Line ®DefinitionsAppeal (Part A, B, C and D): A special kind of complaintyou make if you disagree with certain kinds of decisionsmade by Original Medicare or by your health plan. Youcan appeal if you request a health care service, supply orprescription that you think you should be able to get fromyour health plan, or you request payment for health careyou already received, and Medicare or the health plan deniesthe request. You can also appeal if you are already receivingcoverage and Medicare or the plan stops paying. Thereare specific processes your Medicare Advantage plan, otherMedicare health plans, Medicare Part D plans, or OriginalMedicare must use when you ask for an appeal.Benefit period (Part A): The way that Original Medicaremeasures your use of hospital and skilled nursing facility(SNF) services. A benefit period begins the day you go intoa hospital or skilled nursing facility. The benefit period endswhen you haven’t received any inpatient hospital care (orskilled care in a SNF) for 60 days in a row. If you go into ahospital or a skilled nursing facility after one benefit periodhas ended, a new benefit period begins. You must pay theinpatient hospital deductible for each benefit period. Thereis no limit to the number of benefit periods.Capitation (Part C): Medicare payment system forMedicare Advantage plans where the plan receives a fixeddollar amount to provide all Medicare covered services foreach Medicare beneficiary enrolled in the plan, no matterhow few or how many services a beneficiary uses.Catastrophic coverage (Part D): This is the higher level ofcoverage (95% or more) you receive for all covered drugsafter you have paid more than $4,550 for your prescriptionsin 2010.COBRA Continuation of Health Coverage(Consolidated Omnibus Budget Reconciliation Actof 1986): Gives workers and their families who losehealth benefits the right to choose to continue grouphealth benefits provided by their group health plan forlimited periods of time under certain circumstances suchas voluntary or involuntary job loss, reduction in the hoursworked, transition between jobs, death, divorce, and otherlife events. The person may be required to pay the entirepremium for coverage up to 102 percent of the cost ofthe plan.Co-insurance (Part A, B, C and D): An amount youare required to pay as your share of the cost for servicesafter you pay any deductibles. Co-insurance is usually apercentage (for example, 20%).Co-payment (Part A, B, C and D): An amount you arerequired to pay as your share of the cost for a medicalservice or supply, like a doctor’s visit or a prescription. A copaymentis usually a set amount, rather than a percentage.For example, you might pay $10 or $20 for a doctor’s visitor prescription.Creditable Prescription Drug Coverage (Part D):Prescription drug coverage (for example, from an employeror union) that is expected to pay, on average, at least asmuch as Medicare’s standard prescription drug coverage.People who have this kind of coverage when they becomeeligible for Medicare can generally keep that coveragewithout paying a penalty, if they decide to enroll inMedicare prescription drug coverage later.Custodial Care (Part A, B and C): Non-skilled personalcare, such as help with activities of daily living like bathing,dressing, eating, getting in or out of a bed or chair, movingaround, and using the bathroom. It may also include thekind of health-related care that most people do themselves,like using eye drops. In most cases, Medicare doesn’t pay forcustodial care.Deductible (Part A, B, C and D): The amount you mustpay for health care, Medicare, prescription drug plan oryour other insurance before it begins to pay.Donut hole (Part D coverage gap): In 2010, once youreach $2,830 in total covered prescription drug costs, youwill have a coverage gap where you must pay the full cost ofyour prescription drugs until your total out-of-pocket drugcosts reach $4,550. This is also known as the donut hole.Durable Medical Equipment (DME): Includes itemssuch as home oxygen equipment, hospital beds, walkers,wheelchairs, commodes, prosthetics, orthotics and othersupplies are covered under Medicare Part B. All DMEproviders must be accredited by Medicare as of Oct. 1,2009.Extra Help with Medicare Prescription Drug Plan Costs(Part D)–also knows as Low Income Subsidy (LIS):A federal subsidy for people with limited income andresources to help pay for Part D. People with Extra Help(LIS) do not have a donut hole and have limited MedicarePart D out-of-pocket costs.Fee-For-Service (FFS): Medicare reimbursement paymentsystem where Medicare pays a provider a fee for each serviceperformed.31