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Term Definition

A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Medically Necessary

Services or supplies that are needed for the diagnosis or treatment of your medical condition, meet the standards of good medical practice in the local area, and aren't mainly for the convenience of you or your doctor.

Medicare Advantage Plan

Health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program.

With Medicare Advantage Plans:

  • You generally get all your Medicare-covered health care through that plan.
  • Coverage can include prescription drug coverage.
  • You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.
  • You may have lower out-of-pocket costs than the Original Medicare Plan.
  • You may have to use the plan's doctors and hospitals to get services.

You don't need to buy a Medigap policy.

Medicare Cost Plan

A Medicare Cost Plan is a type of HMO. These plans may work in much the same way, and have some of the same rules, as Medicare Advantage Plans. In a Medicare Cost Plan, if you go to a non-network provider, the services are covered under the Original Medicare Plan. You would pay the Medicare Part A and Part B coinsurance and deductibles.

Medicare Health Plan

A plan offered by a private company that contracts with Medicare to provide you with your Medicare Part A and Part B benefits, and in most cases, Part D prescription drug benefits. Medicare Health Plans include Medicare Advantage Plans (including HMO, PPO, or Private Fee-for-Service Plans); Medicare Cost Plans; PACE plans; Special Needs Plans; and Demonstrations/Pilot Programs.

Medicare Medical Savings Account (MSA) Plan

A type of Medicare Advantage Plan. Medical Savings Account (MSA) Plans have two parts. The first part is a high-deductible Medicare Advantage MSA Health Plan. This health plan won't begin to pay covered costs until you have met the annual deductible, which varies by plan. The second part is a Medical Savings Account into which Medicare deposits money that you may use to pay health care costs.

Medicare Prescription Drug Plan

A stand-alone drug plan, offered by insurers and other private companies to people with Medicare who receive benefits through the Original Medicare Plan; through a Medicare Private Fee-for-Service Plan that doesn't offer prescription drug coverage; or who have a Medicare Cost Plan, or Medicare Medical Savings Account Plan. Medicare Advantage Plans may also offer qualified prescription drug coverage that must follow the same rules as Medicare Prescription Drug Plan.

Medicare Savings Program

Medicaid programs that help pay some or all Medicare premiums and deductibles.

Medicare SELECT

A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.

Medicare Special Needs Plan

A special type of Medicare Advantage Plan that provides all Medicare Part A and Part B health care and services to people who can benefit the most from things like special care for chronic illnesses, care management of multiple diseases, and focused care management. These plans may limit membership to people

  • in certain institutions (like a nursing home),
  • eligible for both Medicare and Medicaid, or
  • with certain chronic or disabling conditions.

Medicare-approved Amount

In the Original Medicare Plan, this is the amount a doctor or supplier can be paid, including what Medicare pays and any deductible, coinsurance, or copayment that you pay. It may be less than the actual amount charged by a doctor or supplier.

Medigap Policy

Medicare supplement insurance sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Except in Massachusetts, Minnesota, and Wisconsin, there are up to 12 standardized Medigap policies labeled Medigap Plan A through Plan L. Medigap policies only work with the Original Medicare Plan.

Monthly Premium

The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage. In a few cases, a note will say "Under Review" instead of a premium amount. This means Medicare and the company are still discussing the amount.

*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations,and rulings.