Medicare and Caregivers
Medicare and Caregivers: Terms to Know
Here is a list of terms related to Medicare and caregivers.
Assignment
Assignment is an agreement between Medicare doctors, health care providers, and suppliers to accept the Medicare-approved amount as payment in full. If a doctor or supplier does accept assignment, Medicare will pay 80 percent of the cost, and the patient pays the rest.
Benefit Period
This is the way that Original Medicare measures a person's use of hospital and skilled nursing facility (SNF) services. (A skilled nursing facility is a nursing facility with the staff and equipment available to give skilled nursing care and/or skilled rehabilitation services such as changing sterile dressings and physical therapy.) A benefit period begins the day a person goes to a hospital or skilled nursing facility. The benefit period ends when the person hasn't received any inpatient hospital care (or skilled care in an SNF) for 60 days in a row. If a person goes into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. The person must pay the inpatient hospital deductible for each benefit period.
Co-insurance
This is an amount a person may be required to pay for services after paying any plan deductibles. In Original Medicare, this is a percentage (about 20 percent) of the Medicare-approved amount. A person has to pay this amount after paying the Part A and/or Part B deductible. In a Medicare Prescription Drug Plan, the co-insurance will vary depending on how much the person has spent.
Co-payment
In some Medicare health and prescription drug plans, this is an amount a person pays for each medical service, like a doctor's visit, or prescription. A co-payment is usually a set amount. For example, this could be $10 or $20 for a doctor's visit or prescription. Co-payments are also used for some hospital outpatient services in Original Medicare.
Deductible
This is the amount a person must pay for health care or prescriptions before Original Medicare, the prescription drug plan, or other insurance begins to pay. For example, in Original Medicare, a person pays a new deductible for each benefit period for Part A and each year for Part B. These amounts can change every year.
Medicare-approved Amount
In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It includes what Medicare pays and any deductible, co-insurance, or co-payment that the patient pays. It may be less than the actual amount a doctor or supplier charges. If a doctor or supplier does accept assignment, Medicare will pay 80 percent of the cost, and the patient pays the rest.
Premium
This is the periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
State Health Insurance Assistance Program (SHIP)
This is a state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare. (In some states, SHIP is known as SHIBA or SHINE.)
State Medical Assistance Office
This is a state agency that is in charge of the state's Medicaid program and can give information about programs that help pay medical bills for people with limited income and resources.
