Understanding Medicare means understanding the meaning of many unfamiliar terms. The following is a list of words and acronyms that are used when discussing Medicare, or are important to give you a better understanding of how Medicare works.
- Accountable Care Organizations (ACOs)
- Activities of Daily Living (ADL)
- Acute Illness
- Administrative Law Judge (ALJ)
- Advance Beneficiary Notice (ABN)
- Advance Coverage Decision
- Advance Directive
- Advanced Illness
- Affordable Care Act (also known as the Health Care Law)
- ALS (Amyotrophic Lateral Sclerosis)/Lou Gehrig’s Disease
- Ambulette
- Annual Election Period (AEP)
- Annual Notice of Change (ANOC)
- Annual Wellness Visit (AWV)
- Appeal
- Approved Amount
- Area Agency on Aging (AAA)
- Assets
- Assignment
- Assisted Living Facility
- Assistive Technology
- Balance Billing
- Benchmark
- Beneficiary
- Benefit Period
- Bereavement Services
- Brand-Name Drug
- Calendar Quarters
- Capped Rental Item
- Care Manager
- Caregiver
- Catastrophic Coverage
- Centers for Medicare & Medicaid Services (CMS)
- Certificate of Medical Necessity (CMN)
- Chronic Illness
- Claim
- COBRA (Consolidated Omnibus Budget Reconciliation Act)
- Coinsurance
- Competitive Bidding
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Continuous Open Enrollment
- Conversion Policy
- Coordination of Benefits
- Coordination Period, 30-Month
- Cost Plan
- Cost-sharing
- Cost Tiers
- Coverage Gap
- Coverage Restrictions
- Creditable Coverage
- Curative Care
- Current Work
- Custodial Care
- Deductible
- Demand Bill
- Denial of Coverage
- Department of Veterans Affairs (VA)
- Detailed Explanation of Non-Coverage (DENC)
- Detailed Notice of Discharge
- Dialysis
- Disability
- Discharge
- Discharge Plan
- Disenrollment
- DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies)
- Donut Hole
- Drug Class
- Drug Tiers
- Dual Eligible
- Durable Medical Equipment (DME)
- Durable Medical Equipment Medicare Administrative Contractor (DME MAC)
- Earned Income
- Elimination Period
- Employer Group Health Plan
- End-Stage Renal Disease (ESRD)
- Enrollment
- Enrollment Periods
- Evidence of Coverage (EOC)
- Exception Request
- Excess Charge
- Expedited Appeal
- Explanation of Benefits (EOB)
- Extra Help
- Extra Help Premium Amount
- Fall Open Enrollment
- Federal District Court
- Federal Employees Health Benefits (FEHB)
- Federal Poverty Level (FPL)
- Federally Qualified Health Center (FQHC)
- Fee-for-Service
- Formulary
- Formulary Restrictions
- Free Look Period
- Gaps in Coverage
- Gatekeeper
- General Enrollment Period (GEP)
- Generic Drug
- Grievance
- Group Health Plan (GHP)
- Guaranteed Issue Right
- Health Care Provider
- Health Care Proxy
- Health Insurance
- Health Maintenance Organization (HMO)
- Hill-Burton Program
- Home Health Agency (HHA)
- Home Health Aide
- Home Health Care
- Homebound
- Homemaking Services
- Hospice
- Hospital Insurance
- Hospital-Issued Notice of Non-Coverage (HINN)
- In-Network
- Income-Related Monthly Adjustment Amount (IRMAA)
- Independent Review Entity (IRE)
- Individual Policy
- Initial Coverage Election Period
- Initial Enrollment Period (IEP)
- Inpatient
- Inpatient Care
- Integrated Care
- Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
- Language Therapy
- Late Enrollment Penalty
- Lifetime Reserve Days
- Limiting Charge
- Living Will
- Long-Term Care Insurance
- Long-Term Care Ombudsman
- Long-Term Services and Supports (LTSS)
- Low-Income Subsidy (LIS)
- Maintenance Care
- Managed Long-Term Care (MLTC)
- Marketing Violations
- Marketplaces (also known as Exchanges)
- Maximum Out-of-Pocket (MOOP)
- MAXIMUS
- Medicaid
- Medicaid Buy-In
- Medicaid Spend-Down
- Medical Insurance
- Medical Supplies
- Medically Necessary
- Medicare
- Medicare Administrative Contractor (MAC)
- Medicare Advantage
- Medicare Advantage Drug Plan
- Medicare Advantage Open Enrollment Period (MA OEP)
- Medicare Advantage Plan Card
- Medicare Appeals Council (Council)
- Medicare-Approved Amount
- Medicare Card
- Medicare-Certified
- Medicare Fraud
- Medicare Medical Savings Account (MSA)
- Medicare Prescription Drug Benefit
- Medicare Private Drug Plan
- Medicare Private Health Plan
- Medicare Savings Program (MSP)
- Medicare SELECT
- Medicare Summary Notice (MSN)
- Medicare Supplement
- Medigap
- Medigap Open Enrollment Period
- National Coverage Determination (NCD)
- Network
- Non-Participating Provider
- Notice of Medicare Non-Coverage (NOMNC)
- Nursing Home
- Observation Stay
- Occupational Therapy
- Off-Label
- Opt-Out
- Original Medicare
- Out-of-Network
- Out-of-Pocket Costs
- Out-of-Pocket Limit
- Outpatient Care
- Outpatient Prospective Payment System (OPPS)
- Over-the-Counter Drug
- Palliative Care
- Part A
- Part B
- Part C
- Part D
- Participating Provider
- Pastoral Care
- Patient Assistance Program (PAP)
- Personal Care
- Pharmacotherapy
- Physical Therapy
- Plan of Care
- Point-of-Service (POS) Option
- Power of Attorney
- Pre-Existing Condition
- Pre-existing Condition Waiting Period
- Preferred Pharmacy
- Preferred Provider Organization (PPO)
- Premium
- Premium Penalty
- Prescription
- Prescription Drug
- Prescription Drug Insurance
- Prescription Drug Plan (PDP)
- Preventive Care
- Primary Care Provider (PCP)
- Primary Insurance
- Prior Authorization
- Private Duty Nursing
- Private Fee-for-Service (PFFS) plan
- Private Health Plan
- Program of All-Inclusive Care for the Elderly (PACE)
- Provider
- Provider-Sponsored Organization (PSO)
- QIO Review
- Qualified Disabled Working Individual (QDWI)
- Qualified Health Plan (QHP)
- Qualified Independent Contractor (QIC)
- Qualified Medicare Beneficiary (QMB)
- Qualifying Individual (QI)
- Quality Improvement Organization (QIO)
- Quantity Limit
- Railroad Medicare Carrier
- Railroad Retirement Board
- Reconsideration
- Red, White, and Blue Card
- Redetermination
- Referral
- Rehabilitation Therapy
- Reserve Days
- Respite Care
- Retiree Insurance
- Retroactive Disenrollment
- Secondary Insurance
- Service Area
- SHIP (State Health Insurance Assistance Program)
- Skilled Care
- Skilled Nursing Facility (SNF)
- Skilled Nursing Services
- Skilled Therapy Services
- Social Security Administration (SSA)
- Social Security Credits
- Special Election Period
- Special Enrollment Period (SEP)
- Special Needs Plan (SNP)
- Specialist
- Specified Low-Income Medicare Beneficiary (SLMB)
- Speech Therapy
- Speech-Language Pathology
- State Pharmaceutical Assistance Program (SPAP)
- Step Therapy
- Supplemental Security Income (SSI)
- Supplier
- Take Assignment
- Terminal Illness
- Tiering Exception
- Tiers
- Transition Refill
- TRICARE
- TRICARE for Life (TFL)
- Unearned Income
- Unskilled Care
- Urgent Care
- Utilization Management Tools
- Veterans Affairs (VA) Benefits
- Waiver of Liability