Glossary of Terms

This glossary explains typical terms used in Medicare. It is organized alphabetically by term.

ALS or Lour Gehrig’s disease - Amyotrophic lateral sclerosis or ALS is a neurodegenerative disease which progressively affects nerve cells especially in the brain and spinal cord. When the muscle does not get any nourishment, the muscle wastes away (atrophies) which may result in people losing the ability speak, eat, move and breathe. 

Blood transfusion – A blood transfusion is a safe, common procedure in which blood is given intravenously. Blood transfusions are done to replace loss of blood during surgery or due to a serious injury or condition.

Chiropractic care - Chiropractic care is a natural form of health care that uses spinal adjustments to correct any misalignment. Chiropractic care tries to restore normal functions to the nervous system through natural processes of body healing. There is no surgery or drugs involved in Chiropractic care.

Clinical lab services – Clinical laboratory services may include tests done on clinical specimens to diagnose the health of a patient.

CMS - The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the  Department of Health and Human Services (HHS), that administers the Medicare program. 

COBRA – The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides for employees to continue their health insurance coverage after leaving employment for a limited period. The ex-employee pays for both the employee and employer portions of the cost.

Copay/Coinsurance – Copay/Coinsurance is part of cost-sharing and refers to money that an individual is required to pay for healthcare  services after a deductible has been applied. Copay is usually a flat amount for a specific service, while Coinsurance is often specified as a percentage.

Coverage gap – Refer ‘Donut hole.'

CREDITable coverage – Creditable prescription drug coverage means that the coverage is expected to pay on average of at least as much as the standard Medicare prescription drug plan. If yes, the coverage is recognized as equivalent to Medicare Part D coverage.

Deductible – In an insurance policy, the deductible is the amount of money that must be paid out-of-pocket before the insurer will pay for any covered expenses.

Dialysis - Dialysis is the artificial process of eliminating waste and unwanted water from the blood. Some people may have kidney damage or failure due to which they may need dialysis on a regular basis.

Donut hole - The Medicare Part D coverage gap is the amount between the initial coverage limit and the catastrophic-coverage threshold, which the consumer has to pay from one's pocket, without the plan paying anything. This gap is getting smaller every year driven by legislation and is expected to close by 2020.

Durable medical equipment - As the name implies, these are not consumables but refer to durable items like oxygen equipment, wheelchairs, walkers, and hospital beds, for use at home.

ESRD – End stage renal disease (ESRD) or acute renal (kidney) disease is a condition in which the kidneys do not function over a period. End stage generally implies that kidneys are functioning below 10 per cent of their normal function.

Formulary – A formulary is a list of medicines covered by a prescription drug plan. Each plan may have their own formulary. Plans typically organize covered drugs under different tiers of cost.

HMO - A health maintenance organization (HMO) provides managed health services for a fixed annual fee. You are restricted to a network of providers. Going out of network may either cost more or may not be covered at all.

HMO Point-of-Service (HMO-POS) plans - These are HMO plans that allow you to get services out-of-network for a higher copay or coinsurance.

Home health services - Home health care is a wide range of health care services that can be provided at home such as wound care, intravenous or nutrition therapy, injections and monitoring serious illness or health status.

Hospice care - Hospice care focuses on the palliation of a chronically ill or terminally ill patient's plan and symptoms, attending to their needs, be it emotional or spiritual.

Hospitalisation - This is inpatient care. Under Medicare Part A you are eligible to get yourself admitted to a hospital in a semi-private rooms with meals, general nursing, and drugs as well as other hospital services and supplies as part of your inpatient treatment.

Kidney Transplantation –  Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease.

Long-term care hospitals – Some people and conditions need longer hospital stays. Long? term care hospitals (LTCHs) are certified as acute ?care hospitals.

Medicaid - Medicaid is a joint federal and state program that helps people with limited income and resources with healthcare costs. There is no age bar. Medicaid also offers some benefits not usually covered by Medicare, like nursing home care and personal care services. People who are eligible for both Medicare and Medicaid are called "dual eligibles."

Medicare Advantage Plan – Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies. Medicare pays these companies to cover your Medicare benefits. Part C may be viewed as a substitute for Medicare Part A and Part B. You will need to continue paying your Part B premium.

Medicare Supplement - Medicare Supplement plans/policies are sometimes also referred to as Medigap. This is insurance supplemental to Medicare Part A and Part B. It helps in paying some of the healthcare costs that are not covered by Medicare. It could include copays, coinsurance, and deductibles. Some Medicare Supplement policies also cover emergency medical care when you travel outside the United States.

Pain management – Pain management or Algiatry, is a branch of medicine employing an interdisciplinary approach to ease a patient's suffering and improving the quality of life, especially for those living with chronic pain. A typical pain management team includes medical practitioners, pharmacists, and clinical psychologists.

Preferred Provider Organization (PPO) plans - Like an HMO, a PPO expects you to stay within its network of doctors, hospitals, and other health care providers. However, you can go outside the network for a higher share of the cost.

Preventive care - Preventive care is preventing or detecting illness at an early stage when treatment is likely to work best. Preventive services usually include exams, shots, lab tests, and screenings. They also include programs for health monitoring, counseling, and education to help you take care of your health.

Private Fee-for-Service (PFFS) plans - PFFS plans are similar to Original Medicare in that it allows you to go to any doctor, other health care provider, or hospital who accept the plan’s payment terms.

Skilled Nursing Facility - Skilled nursing facility provides care and rehabilitation services to help injured, sick or disabled persons to get back on their feet. You may be eligible for SNF if your doctor certifies that it will help improve your medical condition or prevent your condition from getting worse.  SNF may include skilled care like intravenous injections or physical therapy. 

TRICARE - TRICARE is a health care program of the United States Department of Defense. It provides health benefits for US Armed Forces military personnel, military retirees and their dependents, including some members of the Reserve Component.

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