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Glossary

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.

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Term	Definition
PENALTY	An amount added to your monthly premium for Medicare Part B, or for a Medicare Prescription Drug Plan, if you don’t join when you’re first able to. You pay this higher amount as long as you have Medicare. There are some exceptions.
PHYSICIAN SERVICES	Services provided by an individual licensed under state law to practice medicine or osteopathy. Physician services given while in the hospital that appear on the hospital bill are not included.
PLAN ADMINISTRATOR	The person who is responsible for the management of the plan. The plan administrator is a person specifically designated by the terms of the plan. If the plan does not make such a designation, then the plan sponsor is generally the plan administrator.
PLAN SPONSOR	Generally, the employer, the employee organization, (such as a union), or other entity that establishes or maintains an employee benefit plan, including a group health plan. See also Sponsor.
POINT-OF-SERVICE (POS) OPTION	An HMO option that lets you use doctors and hospitals outside the plan for an additional cost.
PRE-EXISTING CONDITION	A health problem you had before the date that a new insurance policy starts.
PREFERRED PROVIDER ORGANIZATION (PPO) PLAN (MEDICARE)	A type of Medicare Advantage Plan in which pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
PREMIUM	The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.
PREVENTIVE SERVICES	Health care to keep you healthy or to prevent illness (for example, Pap tests, pelvic exams, flu shots, and screening mammograms).
PRIMARY CARE DOCTOR	A doctor who is trained to give you basic care. Your primary care doctor is the doctor you see first for most health problems. He or she makes sure that you get the care that you need to keep you healthy. He or she may talk with other doctors and health care providers about your care and refer you to them. In many HMOs, you must see your primary care doctor before you can see any other health care provider.
PRIVATE FEE-FOR-SERVICE PLAN	A type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn’t cover.
PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)	PACE combines medical, social, and long-term care services for frail people to help people stay independent and living in their community as long as possible, while getting the high-quality care they need. PACE is available only in states that have chosen to offer it under Medicaid. To be eligible, you must • be 55 years old or older, • live in the service area of the PACE program, • be certified as eligible for nursing home care by the appropriate state agency, and • be able to live safely in the community.

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.

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