Coverage
This benefit covers inpatient hospital services, hospice care, skilled nursing facility care, and home health care.
What is Part A?
The amount you or your supplemental insurance must pay for services before Medicare begins to pay
What is the deductible
You are automatically enrolled into Medicare Part A and Part B if you are under age 65 and have been receiving this certain type of benefit from the Social Security Administration or Railroad Retirement Board for 24 months.
What are Disability Benefits?
Rights you have in certain situations when insurance companies must sell you certain Medigap policies.
What is guaranteed issue rights, also called Medigap protections?
You do this in NGD to verify the caller's information
What is Pass Disclosure?
A Mammogram, Colonoscopy, Yearly Wellness Visit, Bone Mass Measurement, etc. are examples of these
What are Preventative Services?
This is the additional monthly amount the beneficiary would be required to pay for their coverage if they have a higher income.
What is the IRMAA or Income Related Monthly Adjusted Amount?
These are certain situations that may allow you to join, switch, or disenroll from a plan
What are Special Election Periods?
This group health coverage that is provided by beneficiary or their spouse's former employer or union. This coverage usually fills some of the gaps in Medicare coverage and sometimes includes extra benefits, such as extra days in a hospital.
What is Retiree Coverage?
Protect Privacy, Listen and Take Notes, Restate and Offer to Help, NGD Quick Check, and Ask Questions are part of this
What is the First 5?
Services are considered this if they:
Are needed to diagnose or treat your illness, injury, medical condition, disease, or its symptoms
Meet the accepted standards of medical care
Are not solely for the convenience of you or your doctor
What is Medically Necessary?
The extra amount that the beneficiary will be charged if they go without creditable prescription drug coverage for 63 or more consecutive days any time after you’re first eligible to enroll in a Medicare prescription drug plan.
What is the Late Enrollment Penalty (LEP)
This period occurs when you first become eligible for Medicare at 65 & consists of a total of 7 months beginning the 3 months before your 65th birthday, the month of, and the 3 months following.
What is Initial Enrollment Period?
Plans for people with Medicare who have a severe or disabling chronic condition, such as diabetes, end-stage renal disease (ESRD), HIV/AIDS, chronic heart failure, or dementia.
What is Chronic Special Needs Plan?
These are all-in-one alternatives to Original Medicare offered by private insurance companies and approved by Medicare
What is a Medicare Advantage Plan?
Your provider or supplier gives you this form when they think that Medicare won’t pay for an item or service because it is not medically reasonable or necessary.
What is an Advance Beneficiary Notice of Noncoverage, also known as an ABN?
Providers can charge up to 15% more than the Medicare-approved amount.
What are limiting charges?
How long a beneficiary has to enroll in Medicare once they stop working or lose their employer coverage, whichever comes first
What is 8 months?
When Medicare sends a beneficiaries claim payment information to their supplemental insurance company
What is Supplemental Crossover of Claims?
You select this view in NGD when you want to review how much a beneficiary is billed
What is the Premium Summary View?
You would go to this script to view coverage information for walkers, wheelchairs, oxygen, etc
What is Durable Medical Equipment (DME)?
This is the set amount that Medicare will pay for each Part B covered service or item a beneficiary receives
What is Medicare-Approved Amount?
This plan's open enrollment begins when the beneficiary has both Part A and Part, lasts for only 6 months & once started can't be stopped, restarted, or repeated
What is a Medigap policy?
When a beneficiary has other insurance that pays their healthcare bills before Medicare
What is Medicare Secondary Payer?
Medicare pays this fixed amount to beneficiaries Medicare Advantage plan each month for their care.
What is Capitation Rate?