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Health Insurance Today

Medicare was established by Congress in 1966 to provide financial assistance with medical expenses to:
People older than 65, people with end-stage renal disease, and people younger than 65 with disabilities.
Cost Sharing
Medicare requires its beneficiaries to pay premiums deductibles and coinsurance,
Taxes withheld from employees' wages and Taxes paid by employers
Medicare Part A, the hospital insurance part of Medicare, is funded.
Medically Necessary
Coverage requirements under Medicare state that for a service to be covered, and considered.
Part A coverage is available free of charge to eligible Medicare beneficiaries who:
Are eligible to receive Social Security benefits.
Fiscal Intermediary (FI)
A private organization that contracts with Medicare to pay Part A and some Part B bills and determines payment to Part A facilities.
Medicare Part B helps pay for:
Medically necessary physician's services.
Medicare Pays
80% of allowable charges after the annual deductible is met.
Benefit Period
Is the duration of time during which a Medicare beneficiary is eligible for Part A benefits for services incurred in a hospital or skilled nursing facility(SNF) or both.
Medicare Part C
Managed Healthcare plans that offer regular Part A and Part B Medicare coverage and additional coverage for certain other services.
Medicare Part D
The prescription drug coverage plan, which began in January 2006.
Donut Hole
The period during which a Medicare beneficiary is responsible for all prescription drug expenses until a total of $3850 (2007 figure) is spent out -of-pocket.
Dual Eligible
An individual qualifying for Medicare and Medicaid benefits.
The program that provides community-based acute and long-term care services to Medicare beneficiaries.
Supplemental Policy
A health insurance plan sold by private insurance companies to help pay for healthcare expenses not covered by Medicare.
Medicare Secondary Payer(MSP)
When another insurance policy is primary to Medicare.
Some Medicare health maintenance organization(HMO)enrollees allowed to see specialist outside the "network" without going through a primary care physician.
Provider sponsored organization
A group of medical providers that skips the insurance company middleman and contracts directly with patients.
Local medical review policies (LMRPs) were replaced in 2003.
A form that Medicare requires all health care providers to use when Medicare does not pay for a service.
Program of All-Inclusive Care for the Elderly
The program that provides community based acute and long-term care services.
A health insurance plan sold by private insurance companies to help pay for expenses not covered by Medicare.
Open Enrollment
The time period Medicare allows for enrolling in Medicare supplemental plan without penalty
The term when Medicare is not the primary pauer, and the beneficiary is covered under another insurance policy.
COB Contractor
The individual responsible for initial MSP development activities formerly performed by Medicare FIs and carriers.