Glossary

Common Medicare Words or Phrases You Might See

Advanced Directives means, a written instruction, such as a living will or durable power of attorney for health care, recognized under State law identifying how you want your health care provided if you are unable to make your own decisions. The Arizona State Attorney General website offers documents that you can use in the State of Arizona to assist you in completing your Advance Directives. Once completed you should provide a copy to your physicians, your hospital and your designated Medical Power of Attorney. You can also go to the Arizona State Attorney General website and download copies of the forms for use to complete.
www.azag.gov

Advance care planning is a process used to identify a person's preferences regarding care and treatment at a future time including a situation in which the a person lacks the capacity to do so; for example, when a situation arises in which life-sustaining treatments are a potential option for care and the resident is unable to make his or her choices known.

In Original Medicare a benefit period begins on the first day you go into a hospital or skilled nursing facility and ends when you have been out of the hospital or skilled nursing facility for 60 consecutive days.

The federal agency that runs the Medicare program. In addition, CMS works with the states to run the Medicaid program.

The percent of the Medicare-approved amount that you have to pay for a covered medical service. For example, if your coinsurance is 20 percent and Medicare approves a $100 doctor office visit, Medicare will pay $80 and you will pay $20. With some plans, you do not pay coinsurance until you have first paid a deductible.

In some Medicare Advantage and other health plans, this is the set amount you pay for each medical service or prescription drug you receive. For example, you may need to pay a $10 copay each time you see the doctor or pick up a prescription. Copays are also required for some hospital outpatient services in the Original Medicare plan.

This is the portion of a medical service or prescription drug that you pay. Types of cost sharing include copayments, coinsurance, or deductible. Some plans have limits on the total amount of cost sharing you pay in a year. For example, a plan may require that you pay 25 percent of the drug costs and the plan will pay 75 percent, up to a combined total of $2,000. Some plans may have flat (dollar-amount) copayments for each prescription instead of a percentage.

A set amount of money you must pay before you receive any coverage for medical services or prescription drugs. Generally, deductibles are annual and apply to Medicare Parts A, B, and D. Deductibles may also apply to Medicare Advantage and Supplement plans.

A Medicare Advantage plan is a program under which a non-government company arranges for all Medicare covered services, including physicians, labs and hospitals. Some Medicare Advantage and other health plans may offer the Medicare Prescription Drug Benefit to their enrollees.

A Medicare Part D Prescription Drug Plan may be either a stand-alone Prescription Drug Plan that you can join if you have Original Medicare or a Medicare Advantage plan (or other health plan) also may include Medicare prescription drug coverage.

Insurance, sold by private companies, that you may purchase to help cover some of the expenses Medicare does not. These plans are also called "Medigap" plans.

Medicare Part A typically pays for inpatient hospital expenses.

Medicare Part B typically covers outpatient health care expenses, including doctor fees.

The part of the Medicare program that provides prescription drug coverage.

Your payment to an insurance carrier for medical benefits purchased.