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CMS Terminology

CMS Terminology
Across
Federal government health insurance program that provides health care coverage if you are 65 or older
the part of Medicare that provides prescription drug coverage.
Before your plan will cover a drug, you must first try a different or less expensive drug that treats your condition to see if it will be effective for you.
Supplemental health insurance policy that is sold by private insurance companies and works only with Original Medicare.
Not part of a private health plan’s network of health care providers.
Nursing home that provides skilled care
drug that can be obtained only if you have a prescription from a provider.
You typically pay less for your prescription drugs when purchased here.
Patient who has not been formally admitted into the hospital
Set amount you are required to pay for each medical service you receive (like $35 for a doctor’s visit).
authorizations that Medicare Advantage Plans usually require for services not provided by your primary care provider (PCP).
May be known to some as the "donut hole."
Down
Immediate medical attention for a sudden illness or injury that is not life threatening.
The amount you must pay for health care expenses before your health insurance begins to pay.
Federal program administered by Social Security that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, including coinsurances, deductibles, and premiums.
health care costs that you must pay because Medicare or other health insurance does not cover them.
Annual summary of any changes in the plan’s costs and coverage that will take effect January 1 of the next year.
Care intended to prevent illness, detect medical conditions, and keep you healthy.
amount you may pay in addition to your Part B or Part D premium if your income is above a certain level.
A system that Part D plans use to price prescription drugs.