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Medicare Advantage Payments

Payments made to private companies or non-profits that offer Medicare Advantage plans.

Medicare Beneficiary Drug Rebate

Under the Affordable Care Act, a one-time, tax-free $250 rebate offered to eligible Medicare beneficiaries who surpass Part D prescription drug coverage limits - an area colloquially referred to as the "donut hole". The rebate serves to assist Medicare enrollees with limited incomes to afford the medications they need.

Medicare Bundled Payment Pilot Program

A program in which care providers are paid based on expected courses of treatment. This differs from fee-for-services systems in that payments are made based on standard care practices, and, in doing so, is designed to reduce unnecessary treatment procedures.

Medicare Drug Coverage Gap or “Donut Hole”

A gap in coverage where the beneficiary pays 100% of drug costs up to a limit, created by Medicare Part D legislation. Affordable Care Act addresses this by offering rebate checks for participants who reach their coverage gap and by requiring pharmaceutical companies to offer discounts to consumers.

Medicare Independence at Home Program

A program designed to provide qualifying Medicare beneficiaries with in-home care.

Medicare Modernization Act (MMA)

Provided a new Medicare prescription drug benefit (Part D), made changes in Medicare and Medicaid, coverage and payments.

Medicare Part A

Section of Medicare that includes medically necessary hospital, skilled nursing facility, home health and hospice care.

Medicare Part B

Section of Medicare that includes medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health and some home health and ambulance services.

Medicare Part C

More commonly known as Medicare Advantage, a health insurance program of managed health care approved by Medicare and provided by private companies. Medicare Advantage plans combine Medicare Part A (hospital coverage) and B (doctor coverage) plus additional benefits all in one plan.

Medicare Part D

A program within Medicare to offer private prescription drug coverage plans to beneficiaries. Plan premiums are subsidized and the coverage is optional.

Direct Access

A provision of some health insurance plans that allows policy holders to see doctors or specialists without a referral from a primary care physician or…