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Terms Made Easy Understanding
Medicare Supplement and Medicare Advantage plans is much easier once you understand
the terminology. This glossary explains the most common terms. If
there is something you still don’t understand, just give us a call or send
an email to questions@MedigapAdvisors.com.
- Coinsurance:
like a copayment, coinsurance is a charge you must pay for certain health services
covered by your plan. Coinsurance is usually stated as a percentage of eligible
expenses, such as 20 percent of the eligible expenses for radiology services.
- Copayment (Copay): the fee you pay at the time you receive a covered health service. A copayment is generally a fixed dollar amount, such as $20 each time you have an office visit with a specialist.
- Deductible: the amount you must pay for health care before the insurance company or Medicare begins to pay. Note: In many cases, a higher deductible can result in a lower premium payment for the same coverage.
- Guaranteed Issue Rights (also called “Medigap Protections): rights you have during certain periods where an insurance company cannot deny you a Medigap policy, place exclusions on the policy, or rate up the premium because of a pre-existing health problem
- Excess Charge: The amount over the Medicare-approved amount that you may be charged by a doctor or other health care provider
- Maximum Out-of-Pocket Costs: the maximum amount of money the beneficiary you have to pay during a specific period.
- Medicare Advantage: also called Medicare part C, these are plans operated by private companies that pay all of what Medicare Covers, plus additional benefits.
- Medicare-approved Amount: The amount that a doctor or supplier that accepts Original Medicare can be paid by Medicare, including any deductibles, coinsurance, or copayment. This amount may be less than the actual amount charged.
- Open Enrollment Period: The original period when you can sign up for a Medigap policy without having to go through an underwriting process. Some states have additional open enrollment rights.
- Part D: Prescription drug coverage, available as a separate plan or as part of a Medicare Advantage plan
- Pre-existing Condition: a health problem you had before the date that a new insurance policy starts.
- Premium: the monthly fee you pay to a health plan in exchange for coverage.
- State Health Insurance Assistant Program (SHIP): A state program that provides free local health insurance counseling to people with Medicare.
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