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Glossary

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Term Definition
Deductible

The amount you must pay for health care or prescriptions, before Original Medicare, your Medicare drug plan, your Medicare Health Plan, or your other insurance begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.

Demonstration/Pilot Program

Special projects that test improvements in Medicare coverage, payment, and quality of care. Some follow Medicare Advantage rules, but others don't. Demonstrations are usually for a specific group of people and/or are offered only in specific areas. There are also pilot programs for people with multiple chronic illnesses designed to reduce health risks, improve quality of life, and provide savings.
Disenroll

Ending your health care and/or prescription drug coverage with a health plan or drug plan.
Drug Plan Summary Score

This score summarizes the drug plan's quality and performance.

How is the summary score determined?

This score is a summary of the drug plan's performance on 19 different topics in four categories:


  • Drug plan customer service. Includes how well the drug plan handles calls and how well the drug plan makes decisions about member appeals.
  • Member complaints and staying with drug plan. Includes how often members have made complaints against the drug plan and how often members choose to stay with the drug plan from one year to the next.
  • Member experience with drug plan. Combines member satisfaction data collected by Medicare?s annual survey.
  • Drug pricing and patient safety. Includes how well the drug plan is doing with pricing of prescriptions and providing accurate pricing information on the Medicare website, and how often the drug plan's members got certain prescriptions that have a high risk of side effects in patients 65 and older.

Why is the summary score important?

The summary score makes it easy for you to compare drug plans based on quality and performance.


You can look up the drug plan's score in each of the four categories that make up the summary score. You can also look up the drug plan's scores in the 19 individual topics that make up the score in those four categories.

*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.