Ever get confused by different terms used by Medicare or your Medicare Advantage Plan. Here are a few of the more common ones that you need to be familiar with. Test yourself and see how many you get right.
Accepts Assignment: An agreement that your health care provider will accept the Medicare-approved amount for services as full payment limiting your share of the cost to your coinsurance and deductible.
Benefit Period: A benefit period begins the day you are admitted as an inpatient to a hospital or skilled nursing facility and ends when you haven’t received any inpatient hospital care (or skilled care) for 60 days in a row. You may be in the hospital more than once during a benefit period. There’s no limit on the number of benefit periods Medicare will cover. Part A charges a deductible for each benefit period.
Coinsurance: The percent of the cost of a service which you pay. For example, Medicare pays 80% and you would pay 20% as coinsurance.
Deductible: A fixed amount that you pay for your medical care first, before insurance or Medicare starts to pay.
Lifetime Reserve Days: For Medicare Part A, there are a set number of hospital days you can draw on if your stay lasts longer than 90 days in a benefit period. You have 60 lifetime reserve days. A lifetime reserve day cannot be replaced.
Medicare-approved amount: In Original Medicare, this is the amount health care providers who accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. Providers who accept Medicare but not assignment can charge up to 15% above this amount.
Out of pocket limit: A limit that Medicare Advantage plans set on what you will have to personally spend in a plan year. For Medicare Part D plans, this is the maximum amount of money you will have to spend out of your own pocket before catastrophic coverage kicks in for the year.
If you have more questions, please join me for my class, Getting Started with Medicare. It will help you gain a basic understanding of Medicare, Medicare Advantage Plans and many other terms you’ll need to know. For a list of all my upcoming classes, visit my website at www.mutskoinsurance.com/seminars. (Pre-registration is required. These events are only for educational purposes and no plan specific benefits or details will be discussed.)