Medicare Options Glossary | Welcome to Blue Cross Blue Shield of Massachusetts

Coinsurance

The percentage you may have to pay after you pay any plan deductibles. In Original Medicare, this is a percentage (like 20%) of the Medicare approved amount.

Copayment

A set dollar amount you pay for each health care service, like a doctor's visit, or prescription filled.

Deductible

The amount you must pay for health care before Medicare begins to pay, either for each benefit period for Part A, or each year for Part B. These amounts can change every year.

Election

Your decision to join or leave the Original Medicare Plan or a Medicare Advantage plan.

Formulary

A list of certain drugs and their proper dosages. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary.

Health Maintenance Organization

A type of Medicare managed care plan where a group of doctors, hospitals, and other health care providers agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. You usually must get your care from the providers in the plan.

HMO

Hospice Care

A special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Hospice care is covered under Medicare Part A (Hospital Insurance).

Inpatient Care

Health care that you get when you are admitted to a hospital.

Medicare Advantage Plan

A health plan, such as a Medicare managed care plan (HMO or PPO) or Private Fee-for-Service plan offered by a private company with a Medicare contract. An alternative to the Original Medicare Plan.

Medicare Coverage

Made up of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). (See Medicare Part A (Hospital Insurance); Medicare Part B (Medical Insurance).)

Medicare Health Plan

A type of Medicare Advantage Plan where, in most cases, you can only go to doctors, specialists, or hospitals in the plan's network.

Medicare Prescription Drug Coverage

Optional Medicare prescription drug insurance that helps pay for prescription medications.

Medigap Policy

Medicare supplement insurance is a Medigap policy. It is sold by private insurance companies to fill gaps in Original Medicare Plan coverage. Medigap policies only work with the Original Medicare Plan.

Original Medicare

A federally funded fee-for-service health plan that lets you go to any doctor, hospital, or other health care supplier who accepts Medicare and is accepting new Medicare patients.

Outpatient Hospital Care

Medical or surgical care that Medicare Part B helps pay for and does not include an overnight hospital stay.

Penalty

An amount added to your monthly premium for Medicare Part B, or for a Medicare Prescription Drug Plan, if you don't join when you're first able to. You pay this higher amount as long as you have Medicare. There are some exceptions.

Preferred Provider Organization

A type of Medicare Advantage Plan in which you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

PPO

Premium

The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.

Primary Care Doctor

A doctor who is trained to give you basic care. In many Medicare managed care plans, you must see your primary care doctor before you see any other health care provider.

Primary Care Physician

A doctor who is trained to give you basic care. In many Medicare managed care plans, you must see your primary care doctor before you see any other health care provider.

Medex

A Medicare supplement (Medigap) policy offered by Blue Cross Blue Shield of Massachusetts.

PFFS

A type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn't cover.