![]() ![]() Hospice care typically focuses on controlling symptoms and managing pain. Under Original Medicare (Parts A & B), this is skilled nursing care and therapy, such as speech therapy or physical therapy, which is provided on a part-time or intermittent basis to those who cannot leave the home.Ĭare for those who are terminally ill. If you go outside the network for services other than emergency care, urgent care or out-of-area renal dialysis, you are responsible for paying for your own care.Ī health insurance plan for which you pay a significant deductible (usually more than $1,000) before the plan begins to help with your costs. Health Maintenance Organization (HMO) planĪ type of Medicare Advantage plan in which you must use doctors and hospitals in the plan's network for your care. Most long-term care is considered custodial care. Prescription drug coverage from a health plan other than a Medicare Part D standalone plan or a Medicare Advantage plan that includes prescription drug coverage and is at least as good as Medicare Part D.Ĭare that provides help with the activities of daily living, like eating, bathing or getting dressed. Deductibles, copays, coinsurance and other payments count toward the out-of-pocket limit, but premiums do not. You remain in the coverage gap stage until you have spent your plan's out-of-pocket limit in a single year. This amount is determined by the plan, but Medicare establishes a maximum. You enter the coverage gap when you, others on your behalf, and the plan together have paid a pre-set amount for your drugs. This is the cost-sharing stage of a Medicare Part D plan in which you pay most of the plan's discounted price for your covered medications. The most common types of cost-sharing are deductibles, copays and coinsurance. Also called a "copay."Ī term for the way Medicare shares your health care costs with you. In a Medicare Part D plan, for example, you might pay a $15 copayment for each prescription you fill. These plans are also referred to as "managed care plans."Ī pre-set, fixed amount that you pay for a service at the time you receive it. Plan members usually need to use doctors and hospitals that are within the plan's network. In Medicare Advantage (Part C), this refers to a kind of health care plan that links providers and services to deliver efficient, cost-effective patient care. For example, Medicare Part B might pay 80% of the cost of a medical service and you would pay 20%. If you qualify for COBRA coverage, then you have the option of continuing your employer-sponsored health plan for a limited period of time.Ī percentage of the cost for a service, which you split with your plan. It's a law that protects you and your family if you lose your employer-sponsored health benefits. The federal government agency that runs the Medicare program and works with the states to manage their Medicaid programs.ĬOBRA stand for Consolidated Omnibus Budget Reconciliation Act. A cost-sharing stage in Medicare Part D during which you pay only a small copay or coinsurance for a covered drug and your plan pays the rest of the cost.Ĭenters for Medicare & Medicaid Services (CMS)
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