|If I Qualify for Extra Help, will My Full Premium be Covered?||
When using the Medicare Prescription Drug Plan Finder, if $0 appears under the premium column, it means that the extra help you are receiving will cover the premium for that plan. If an amount of $1 or greater appears under the premium column, it means you will have to pay part of the premium because the extra help won't cover all of it. You would be responsible for paying this monthly amount if you choose to enroll in that plan.
An independent reviewer, also known as an independent review entity or IRE, is an outside organization that has a contract with Medicare. If you appeal a decision about your coverage or if your plan doesn't make a timely appeals decision, the IRE may review your case. The IRE has no connection to the plan. Refer to your plan's explanation of coverage (EOC) for more details about the appeals process.
|Initial Coverage Limit||
Once you have met your yearly deductible, and until you reach the $2400 maximum, you pay a copayment (a set amount you pay) or coinsurance (a percentage of the total cost) for each covered drug.
Doctors, hospitals, pharmacies, and other healthcare providers that have agreed to provide members of a certain insurance plan with services and supplies at a discounted price. In some insurance plans, your care is only covered if you get it from in-network doctors, hospitals, pharmacies, and other healthcare providers.
*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.