A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.[Read more...]

An amount patients pay for their share of the cost of medical service or supply, like a doctor’s visit, hospital inpatient visit, or prescription drug.[Read more...]

A coverage determination is the first decision made by a Medicare Part D plan (not the pharmacy) about a plan member's drug benefits.[Read more...]

A period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage.[Read more...]

Creditable coverage refers to health insurance or prescription drug benefits that meet Medicare's minimum qualifications necessary to avoid a penalty.[Read more...]

Non-skilled personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom.[Read more...]

A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.[Read more...]

Dual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.[Read more...]

Durable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds.[Read more...]

End-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age.[Read more...]

Enrollment periods are designated time periods to enroll or disenroll from the various parts of Medicare. There are six Medicare enrollment periods.[Read more...]

In a Medicare Part D plan, an exception is a type of prescription drug coverage determination. You must request an exception, and your doctor must send a supporting statement explaining the medical reason for the exception.[Read more...]

A Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment.[Read more...]

Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium and copayment assistance.[Read more...]

A qualified researcher has reviewed the content on this page to ensure it is factually accurate, meets current industry standards, and helps readers achieve a better understanding of Medicare health insurance and Medicare coverage topics.[Read more...]