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Glossary

Medicare Language Made Simple: Glossary of Key Terms

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A

Accountable Care Organizations (ACO)

Advance Beneficiary Notice of Noncoverage (ABN)

Advance Coverage Decision (ACD)

Advance Directive

ALS

Annual Election Period

Appeal

Assignment of Benefits

Ambulatory Surgical Center (ASC)

B

Beneficiary and Family Centered Care–Quality Improvement Organization (BFCC-QIO)

Benefits Coordination & Recovery Center (BCRC)

C

Certified (Certification)

Claim

Clinical Breast Exam

Comprehensive outpatient rehabilitation facility (CORF)

Coverage determination (Part D)

Creditable Coverage

Critical access hospital (CAH)

D

Diethylstilbestrol

Durable power of attorney (DPOA)

E

End-Stage Renal Disease (ESRD)

F

G

Group Health Plan

Guaranteed Issue Rights (also called “Medigap Protections”)

Guaranteed Renewable Policy

H

Healthcare Provider

Health Insurance Marketplace

Home Health Agency

Home Healthcare

I

Income Related Monthly Adjustment Amount (IRMAA)

Independent reviewer

Initial Coverage Election Period (ICEP)

Initial Enrollment Period (IEP)

Inpatient Rehabilitation Facility

L

Large Group Health Plan

Lifetime Reserve Days

Limiting Charge

Long-Term Care Hospital

Long-Term Care Ombudsman

M

Medical Underwriting

Medically Necessary

Medicare Advantage Plan (Part C)

Medicare Cost Plan

Medicare Drug Coverage (Part D)

Medicare Drug Plan (Part D)

Medicare Health Maintenance Organization (HMO) Plan

Medicare Health Plan

Medicare Medical Savings Account (MSA) Plan

Medicare Part A (Hospital Insurance)

Medicare Part B (Medical Insurance)

Medicare Preferred Provider Organization (PPO) Plan

Medicare Private Fee-For-Service (PFFS) Plan

Medicare Savings Program

Medicare SELECT

Medicare Special Needs Plan (SNP)

Medicare Summary Notice (MSN)

Medicare-Approved Amount

Medicare-Certified Provider

Medigap Open Enrollment Period

Multi-employer plan

O

Open Enrollment Period (OEP)

Original Medicare

Out-Of-Pocket Costs

P

Point-Of-Service Option

Power of attorney

Pre-Existing Condition

Preventive Services

Primary Care Doctor

Prior Authorization

Program of All-Inclusive Care for the Elderly (PACE)

R

Rehabilitation Services

Religious Nonmedical HealthCare Institution

S

Secondary Payer

Skilled Nursing Care

Skilled Nursing Facility (SNF)

Skilled Nursing Facility (SNF) Care

Special Enrollment Period (SEP)

State Health Insurance Assistance Program (SHIP)

State Insurance Department

State Medical Assistance (Medicaid) Office

State Pharmaceutical Assistance Program (SPAP)

State Survey Agency

Supplemental Security Income (SSI)

T

Tiers

TTY

U

Urgently needed care

W

Worker’s compensation

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