Medicare Health Insurance: 10 Important Terms

Medicare is unquestionably one of the most confusing elements of the government. Sadly, there isn’t a good deal of information out there which make it easier to understand. To...

Medicare is unquestionably one of the most confusing elements of the government. Sadly, there isn’t a good deal of information out there which make it easier to understand. To assist you, we have made a list of the ten terms you have to be familiar with to better understand Medicare wellness insurance.

10. Coinsurance

This is the amount that you may be asked to pay when you see a doctor or get medical services. Coinsurance is your share of the cost after you have paid any deductibles. Generally, this price tag represents a proportion of the invoice for services. Thus, if you pay 10% of a $100 service, you will be responsible for $10.

9. Deductible

This is the money you have to pay for health care or prescriptions before your insurance starts to pay. Each plan will have its allowable amount which may be anywhere from $0 to as high as $6,000. A lower deductible increases the whole cost of this plan.

8. Exception

An exception is a sort of Medicare prescription drug policy determination. This is when your plan has made a choice to cover a drug that’s not on its drug list or formulary plan. You and your prescriber can ask for an exception. Your prescriber should provide a statement with a medical explanation of why there should be an exclusion for this particular medication.

7. Extra Help

This is a Medicare program that assists people who have a limit on their income and resources. You can use Extra Help with Medicare Part D. This is Medicare’s prescription plan which helps cover program expenses, premiums, deductibles, and coinsurances. In addition, it can help lower the price of  medications by your plan.

6. Original Medicare 

It is a fee-for-service coverage under Medicare. Your health care is paid for using benefits which you have received over your life of working. Original Medicare is considered Part A and B benefits, which can be your medical and hospital insurance coverage.

5. Medicare Advantage Plan (Part C)

This sort of Medicare health plan is provided by private businesses which connect with Medicare to supply you with all your healthcare needs. Medicare Advantage will give you Part A, B, and D benefits with only 1 premium cost you will pay to the company that you bought the plan from. If you are part of a Medicare Advantage plan, all Medicare services will be dealt with through the plan and will not have to be paid for separately under original Medicare.

4. Medicare Medical Savings Account (MSA) Plan

An MSA plan combines a high deductible Medicare Advantage plan and a bank account. The plan deposits money from Medicare to the account and lets you use this cash to pay for your healthcare expenses. Just Medicare-covered expenses count toward your deductible and this is the one thing you may take advantage of the bank accounts for. The amount deposited is less than your deductible, which means you’ll normally need to pay something out-of-pocket before your policy begins.

3. Medicare Prescription Drug Plan

Medicare Prescription Drug plans can also be referred to as Medicare Part D. This is a standalone plan which provides you prescription drug coverage as well as original Medicare (Part A and B). Private insurances offer Part D. These are approved by Medicare. Medicare Advantage plans usually provide prescription drug coverage that follows the same rules as Medicare Part D.

2. Medicare Private Fee-for-Service (PFFS) Plan

This is a kind of Medicare Advantage Plan that lets you visit any doctor or hospital that you can if you have original Medicare. A PFFS plan determines how much it can pay the hospitals and doctors you see, and how much you have to pay every time you receive health services from. Using a PFFS plan, you’ll have to follow the rules carefully. Expenses that do not receive approval will be an out-of-pocket expense.

1. Premium

A premium is a periodic payment you must make to Medicare, a private insurance provider, or another healthcare plan. You make this payment in exchange for health or prescription drug coverage. Premiums depend on the plan that you pick. You must pay these premiums monthly.