Let’s review a few key insurance terms to make sure you understand what they mean. And, give us a call, if you have any questions about your coverage.
Part A: Government insurance that covers hospital, rehab, part-time or intermittent skilled nursing care and hospice costs.
Part B: Government insurance that covers, doctor visits, ambulance services, durable medical equipment, lab tests, screening and outpatient services.
Part C/Medicare Advantage: They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).
Part D: These plans are offered by insurance companies and private companies approved by Medicare. Medicare Advantage Plan may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare Supplement: Private insurance that helps pay out-to-pocket costs for people with Part A and Part B. This is also called Medigap.
General Health Insurance Terms
These can apply to both Medicare and under-65 health insurance plans.
Premium: The amount you pay for an insurance policy. This can be paid monthly, quarterly or annually.
Deductible: The amount you must pay for care before insurance starts covering your costs.
Co-insurance: A payment for your share of a health care visit service, hospital stay or product this is usually a percentage of the total charge, after you paid you deductible.
Co-pay: A fixed amount you pay for your share of a health care visit, service, hospital stay or product, after you paid your deductible.
HMO: Health maintenance organization is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency.
PPO: A preferred provider organization is a medical care arrangement in which medical professionals and facilities provide services to members at reduced rates. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.