HS 351 Ch. 7
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A federal/state public assistance or welfare program that provides health care benefits based on need. Each state has its own rules that must meet federal guidelines. In return, the federal government finances the major portion of each state's program. At the federal level, Medicaid is administered by the Centers for Medicare and Medicaid Services (CMC), which is part of the U.S. Department of Health and Human Services.
A social insurance program of health benefits for most persons aged 65 or older, although certain younger persons are also eligible for benefits. The program is adminstered by the Centers for Medicare and Medicaid Services (CMS), which is a part of the U.S. Department of Health and Human Services.
Government-run or government regulated insurance programs designed primarily to solve major social problems that affect a large portion of society. Distinguishing characterstics are emphasis on social adequacy, compulsory employment-related coverage, partial or total employer financing, benefits prescribed by law, and benefits as a matter of right.
A principle of social insurance programs under which beneficiaries receive a minimum floor of coverage, regardless of their economic status, individual equity, or need. Coverage above the minimum floor is a personal responsibility.
Original Medicare program
Medicare's traditional pay-per-visit/service benefit arrangement under Part A and Part B.
Medicare secondary rules
Regulations that specify when Medicare will be secondary to an employer's medical expense plan for disabled employees and active employees over age 65.
Medicare Part A
The part of Medicare that covers hospitalization, confinement in certified skilled-nursing facilities, home health care, and hospice care under certain circumstances.
Also known as hospital insurance.
An institution, usually a nursing home, or part of an institution that meets the accreditation criteria required for reimbursement of skilled-nursing care provided to Medicare and Medicaid patients.
See skilled care.
Medicare Part B
The part of Medicare that covers most physicians' services as well as medical items and services not covered under Part A. Part B premiums are deducted from participant's Social Security or railroad retirement benefits.
The program administered by the Centers for Medicare & Medicaid Services that allows Medicare beneficiaries to enroll in certain HMOs. PPOs, and other approved options as alternatives to receiving their benefits under the original or traditional Medicare program; formerly called Medicare+Choice.
Also known as Part C of Medicare.
Medicare Part D
The part of Medicare that, as of 2006, makes perscription drug coverage available to Medicare enrollees.
See Medicare perscription drug plans.
Medicare perscription drug plans
Private perscription drup plans in which Medicare participants can voluntarily enroll. The plans must meet certain standards established by Medicare, and the beneficiaries mus pay a monthly premium.
Under Medicare prescription drug plans, the range in which the beneficiary must pay the full cost of prescription drugs. Under a standard benefit structure, the gap begins after a beneficiary has incurred $2250 of expenses and continues until the plan begins paying again after total drug costs reach $5100.
Also called the doughnut hole.
Creditable prescription drug coverage
Prescription drug coverage under other plans that is deemed to be equivalent to or better than the standard benefit plan for Medicare prescription drug coverage.
Partial advance funding
The funding method used for Medicare. Taxes are more that sufficient to pay current benefits and also provide some accumulation for future benefits.
State Health Insurance Assistance Plan (SHIP)
A state program that gets money from the federal government to give free health insurance counseling and assistance to people with Medicare
Advanced beneficiary notice (ABN)
A notice that a physician, other medical provider, or supplier is required to give a Medicare beneficiary if they think Medicare will not pay for an item or service.
Medicare summary notice (MSN)
A notice to beneficiaries that explains the services and supplies that were billed to Medicare during a 30-day period.
The process used to decide what a patient needs for a smooth transition from one level of care to another.
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