Prescription/medical terms
-an amount you may be required to pay as your share of the cost for services after you ay any deductibles- usually a percentage
What is Coinsurance?
a chart that determines medical cost for a drug.
What is tiers?
a written recommendation from a PCP for a patient to seek medical treatment from a specialist.
What is Referral?
offered by private insurance companies as additional benefits not offered by Medicare.
what is Dental, vision, hearing?
-a fixed amount you pay for a covered service (example $30)
what is copay?
a request to obtain a Part D drug that is not included on a plan sponsors formulary, or a request to have a step therapy, prior authorization or quantity limit waived.
What is Formulary Exception?
- Family medicine Dr. NP, PA, Internist, Pediatrician, Geriatrician (medical dr that is trained to prevent, diagnose, and treat a broad range of illnesses, injuries or diseases)
Who can Be a PCP
can be used to purchase vitamins, toothpaste, cold medicine and more.
What is OTC Catalog benefits
the amount you must pay for health care or prescriptions before insurance begins to pay
What is Deductible?
Being required to try a lower costing prescription drug that treats the condition before "stepping up" to a similar but more expensive medication.
What is step Therapy?
way for medicare receipeint to qualify for medicaid by showing a reduction of income and expenses
what is speed down?
offered by some Medicare advantage plans if you pay your premium through social security, the part B giveback will be credited to your monthly social security check.
What is Part B Premium Reduction
period of time when you may have to pay more for your prescription drugs/temporary limit on what the drug plan will cover, once you and your plan have spent $4,660 on covered drugs in 2023 you will be in a coverage gap. If you get extra help paying for part D, you won’t enter the coverage gap.
What is Coverage Gap
– think of it as a in network pharmacy , where covered drugs are offered at a lower copay
What is Standard Vs Preferred Pharmacy?
what are lower premiums, no deductibles, lower out of pocket, lower copays, choose a pcp , in network only, vs flexibility of Drs., higher premiums, no PCP required, out of network claims at a higher cost, no referrals
What is Difference between HMO vs PPO?
what includes silver sneakers and gym memberships to participating locations
What is Fitness benefits
a one-time fill on a prescription (usually a 30-day fill) that you have been taking that are no longer covered.
What is Transitional Fill
an approval from the plan to see if a prescribed product or service will be covered
What is Prior Authorization
Must Part A and B, qualify for Medicaid, quarterly special enrollment, special need or need for 90 days stay
Who qualifies for DSNP plans? How do you confirm eligibility
covers non-emergency transportation to Dr’s, physical therapy, covered under Medicare advantage, may limited to a specific number of trips.
What is transportation?