Out of Pocket Costs
- A percentage that your are responsible to pay, after you meet your deductible.
What is CoInsurance
Also known as “Donut Hole” is a period in which you and your plan has paid an X dollar amount for Rx drugs in a given year.
Coverage Gap
You would need to get an approval from your insurance provider.
What is Prior Authorization
If you have lower income, Medicaid may help cover costs, such as deductibles and premiums.
What is Extra Help
a set dollar amount that you have to pay for specific services, such as doctors, labs, specialists.
What is a Copayment
In order to be able to determine how much you have to pay, weather in copay or insurance, Prescription drugs are broken down in 4 different categories. (Most Cases)
What is a Tier
A geographic area where the plan is offered, such as city, town, or zipcode.
What is Service Area
includes medical needs and can be used in your home like wheelchairs and walkers. It’s usually covered by health plans.
What is Durable Medical Equipment
A predetermined amount you must pay for your healthcare needs before your insurance starts to cover their portion of the costs.
What is a Deductible
When the drug plan decides to cover a prescription that isn’t on the formulary.
What is a Formulary Exception
Is a resource that allows individuals with communication disabilities to communicate.
What is TTY
shows that you have been covered by a health plan that meets the requirements.
What is Creditable Coverage
The maximum you can spend on health are costs in a given year.
What is MOOP
A formulary is a lists of drugs that are covered under Health Care Plans/Prescription Plans.
Formulary
Is the gap between what your doctor can charge for services and what medicare has approved to pay.
What is Excess Charge
you can use your computer or phone to get seen and treated doctor for non-life threatening in the comforts of your own home.
What is Telemedicine
the amount of money charged by your insurance company for the plan you've chosen.
What is Monthly Premium
Is a way to help lower costs by using less expensive drugs first.
What is Step Therapy
For part A, Your benefit period is every 60 days. So if you go to the hospital, you will have to pay $1,556. If you go back 45 days after your first visit. You will not have to pay again. However, if you go back 61 days after your first visit, You will have to pay that again.
What is Benefit Period
Gives you details about what the plan covers, how much you pay, and more.
What is EOC