This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.
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N | O | P | Q | R | S | T | U | V | W | X | Y | Z |
Term | Definition |
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ELDER LAW* |
The group of laws about rights and issues of the health, finances, and well-being of the elderly. |
ELDERCARE |
Public, private, formal, and informal programs and support systems, government laws, and finding ways to meet the needs of the elderly, including: housing, home care, pensions, Social Security, long-term care, health insurance, and elder law. |
ELECTION |
Your decision to join or leave the Original Medicare Plan or a Medicare+Choice plan. |
ELECTION PERIODS |
Time when an eligible person may choose to join or leave the Original Medicare Plan or a Medicare+Choice plan. There are four types of election periods in which you may join and leave Medicare health plans: Annual Election Period, Initial Coverage Election Period, Special Election Period, and Open Enrollment Period.
|
ELIGIBILITY/MEDICARE PART A |
You are eligible for premium-free (no cost) Medicare Part A (Hospital Insurance) if:
If you are not eligible for premium-free Medicare Part A, you can buy Part A by paying a monthly premium if:
|
ELIGIBILITY/MEDICARE PART B |
You are automatically eligible for Part B if you are eligible for premium-free Part A. You are also eligible for Part B if you are not eligible for premium-free Part A, but are age 65 or older AND a resident of the United States or a citizen or an alien lawfully admitted for permanent residence. In this case, you must have lived in the United States continuously during the 5 years immediately before the month during which you enroll in Part B. |
EMERGENCY CARE |
Care given for a medical emergency when you believe that your health is in serious danger when every second counts. |
EMPLOYER GROUP HEALTH PLAN (GHP) |
A GHP is a health plan that:
|
END-STAGE RENAL DISEASE (ESRD)* |
Kidney failure that is severe enough to need lifetime dialysis or a kidney transplant. |
ENHANCED BENEFITS |
Defined as Additional, Mandatory and Optional Supplemental benefits. |
ENROLL |
To join a health plan. |
ENROLLMENT PERIOD |
A certain period of time when you can join a Medicare health plan if it is open and accepting new Medicare members. If a health plan chooses to be open, it must allow all eligible people with Medicare to join. |
ENROLLMENT/PART A |
There are four periods during which you can enroll in premium Part A: Initial Enrollment Period (IEP), General Enrollment Period (GEP), Special Enrollment Period (SEP), and Transfer Enrollment Period (TEP).
|
EPISODE OF CARE |
The health care services given during a certain period of time, usually during a hospital stay. |
EVIDENCE |
Signs that something is true or not true. Doctors can use published studies as evidence that a treatment works or does not work. |
EXCESS CHARGES* |
The difference between a doctor's or other health care provider's actual charge (which may be limited by Medicare or the state) and the Medicare-approved payment amount. (See Actual Charge; Approved Amount; Medigap Policy.) |
EXCLUSIONS (MEDICARE) |
Items or services that Medicare does not cover, such as most prescription drugs, long-term care, and custodial care in a nursing or private home. |
EXPEDITED APPEAL |
A Medicare+Choice organization's second look at whether it will provide a health service. A beneficiary may receive a fast decision within 72 hours when life, health or ability to regain function may be jeopardized. |
EXPEDITED ORGANIZATION DETERMINATION |
A fast decision from the Medicare+Choice organization about whether it will provide a health service. A beneficiary may receive a fast decision within 72 hours when life, health or ability to regain function may be jeopardized. |
EXPLANATION OF MEDICARE BENEFITS (EOMB) |
A notice that is sent to you after the doctor files a claim for Part B services under the Original Medicare Plan. This notice explains what the provider billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay. This is being replaced by the Medicare Summary Notice (MSN), which sums up all the services (Part A and B) that were given over a certain period of time, generally monthly. (See Medicare Summary Notice; Medicare Benefits Notice.) |
*NOTE: An asterisk (*) after a term means that this definition, in whole or in part, is used with permission from Walter Feldesman, ESQ., Dictionary of Eldercare Terminology, Copyright 2000.
This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations,and rulings.Top of page |
Date Last Updated: September 23, 2004
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