Glossary

Common words or phrases you will see on the BCBSAZ Advantage website. For a comprehensive list, please refer to your Evidence of Coverage (EOC).

Advanced Directives are a written instruments 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 Life Care Planning documents that you can download to assist you with completing your Advance Directives. Once completed and filed with the appropriate parties, you should provide a copy to your physicians, your hospital and your designated Medical Power of Attorney. 

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 individual is unable to make his or her choices known.

The way that both our plan and Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go into a hospital or skilled nursing facility. The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or skilled nursing facility after one benefit period has ended, and a new benefit period begins. There is no limit to the number of benefit periods.

The Federal agency that administers Medicare. To learn more, visit the CMS website

An amount you may be required to pay as your share of the cost for services or prescription drugs. Coinsurance is usually a percentage. For example, if your coinsurance is 20% and Medicare approves a $100 doctor office visit, Medicare will pay $80 and you will pay $20. 

An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or a prescription drug. A copayment is a set amount, rather than a percentage. For example, you might pay $10 or $20 copay for a doctor’s office visit.

Cost-sharing refers to amounts that a member has to pay when services or drugs are received. Cost-sharing includes any combination of the following three types of payments: (1) any deductible amount a plan may impose before services or drugs are covered; (2) any fixed “copayment” amount that a plan requires when a specific service or drug is received; or (3) any “coinsurance” amount, a percentage of the total amount paid for a service or drug, that a plan requires when a specific service or drug is received. A “daily cost-sharing rate” may apply when your doctor prescribes less than a full month’s supply of certain drugs for you and you are required to pay a copayment.

Sometimes called Medicare Part C. A plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. A Medicare Advantage Plan can be an HMO, PPO, a Private Fee-for-Service (PFFS) plan, or a Medicare Medical Savings Account (MSA) plan. When you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under Original Medicare. In most cases, Medicare Advantage Plans also offer Medicare Part D (prescription drug coverage). These plans are called Medicare Advantage Plans with Prescription Drug Coverage. Everyone who has Medicare Part A and Part B is eligible to join any Medicare health plan that is offered in their area, except people with End-Stage Renal Disease (unless certain exceptions apply).

Insurance to help pay for outpatient prescription drugs, vaccines, biologicals, and some supplies not covered by Medicare Part A or Part B.

Medicare supplement insurance sold by private insurance companies to fill “gaps” in Original Medicare. Medigap policies only work with Original Medicare. (A Medicare Advantage Plan is not a Medigap policy.)

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.

The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.