An agreement between a person with Medicare, a doctor or supplier, and Medicare. Doctors or suppliers who accept assignment from Medicare agree to accept the Medicare-approved amount as full payment.
Certificate of Medical Necessity
A form required by Medicare that your physician must complete to get Medicare coverage for certain medical equipment.
An amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Plan, this is a percentage (like 20%) of the Medicare-approved amount. You have to pay this amount after you pay the Part A and/or Part B deductible.
The amount you must pay for health care or prescriptions, before the Original Medicare Plan or other insurance begins to pay. For example, in the Original Medicare Plan, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.
Durable Medical Equipment
Medical equipment that is ordered by a doctor (or, if Medicare allows, a nurse practitioner, physician assistant, or clinical nurse specialist) for use in the home. A hospital or nursing home that mostly provides skilled care can’t qualify as a “home” in this situation. These medical items must be reusable, such as walkers, wheelchairs, or hospital beds.
Services or supplies that are needed for the diagnosis or treatment of your medical condition.
Medicare Advantage Plan (Part C)
A type of Medicare plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Also called Part C, Medicare Advantage Plans are HMOs, PPOs, Private Fee-for-Service Plans, or Medicare Medical Savings Account Plans. If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and are not paid for under the Original Medicare Plan.
Medicare Approved Amount
In the Original Medicare Plan, this is the amount a doctor or supplier that accepts assignment can be paid. It includes what Medicare pays and any deductible, coinsurance, or copayment that you pay. It may be less than the amount a doctor or supplier charges for the item.
Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage. Except in Massachusetts, Minnesota, and Wisconsin, all Medigap policies must be one of 12 standardized Medigap policies labeled Medigap Plan A through Plan L. Medigap policies only work with the Original Medicare Plan.
Equipment that delivers medicine in a mist form to your lungs.
Original Medicare Plan
The Original Medicare Plan has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). It is a fee-for-service health plan. After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
Devices that correct or support the function of body parts. Examples include leg, arm, and neck braces.
Equipment designed to move a patient from a bed or wheelchair.
Devices that substitute for a missing body part. Examples include artificial legs, arms, and eyes.
Medical equipment (other than dental) that replaces all or part of an internal body organ.
Suppliers that participate in Medicare
Participating suppliers must accept assignment for all supply categories (accept Medicare’s approved payment amount as payment in full).
Note: You may pay more for products and supplies from suppliers that do not accept Medicare's approved payment amount as payment in full.