G-L M-S Assignment: A doctor agrees to accept the Medicare-approved amount as full payment for
a patient’s treatment under Original Medicare. Ohio law prohibits medical practitioners and
their employers from charging more than Medicare approves. Most Ohio doctors accept
Medicare assignment.
Benefit period: Medicare measures your use of hospital and skilled nursing facility services by
benefit periods. A benefit period begins the day you are admitted and ends when you’ve
received no skilled services at a hospital or skilled nursing facility for 60 days in a row. A new
benefit period begins with a new admission. You pay the Part A deductible for each benefit
period. There’s no limit to benefit periods.
Crossover: A provision in many MedSup policies that allows Medicare to send claims
directly to the MedSup insurance company. Without crossover, Medicare mails you the
claims and you must send them to the insurer.
Deductible: An amount you pay for Medicare covered services before Medicare begins to
pay. The Part A deductible is paid per benefit period; the Part B deductible is paid annually.
Deductible amounts can change every year.
Durable Medical Equipment (DME): Medical equipment ordered by a doctor for home use.
These items must be reusable (examples: walkers, wheelchairs, hospital beds).
End-Stage Renal Disease (ESRD): Permanent kidney failure. Treatment may be lifetime dialysis or a kidney transplant.
Excess charges: Any amount the doctor or supplier charges you that is more than Medicare approves.
Ohio law prohibits this, but other states may allow these charges.
Guaranteed issue rights: In certain situations, rights you have that require an insurance
company to sell or offer you a MedSup policy. The company cannot deny you coverage or
place conditions on a policy, it must cover your pre-existing conditions and it cannot charge
more for a policy because of your past or present health problems.
Guaranteed renewable: Your MedSup policy must be automatically renewed or continued
unless you commit fraud or don’t pay premiums.
Lifetime reserve days: The 60 days Medicare pays for when you already have been in a
hospital for more than 90 days. These 60 days can be used only once during your lifetime. For
each lifetime reserve day, Medicare pays all covered costs except for your daily copay.
Low-income subsidy (extra help): Financial assistance that helps people who qualify pay
costs associated with Part D coverage.
Medicaid: A program funded by federal and state money that helps pay medical costs for
some people with low incomes and limited resources. Medicaid programs vary from state
to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Medicare Advantage: Medicare health plans that must include all benefits Medicare offers
and may carry extra benefits as well. Medicare contracts annually with private companies to
offer these plans. They are available based on the county where you live.
Medicare-approved amount: In Original Medicare, an amount Medicare sets as
reasonable for a covered medical service. Between you (or your MedSup insurance) and
Medicare, this is the amount paid to a doctor or other provider for a service or supply. Ohio law
prohibits medical practitioners and their employees from charging more than Medicare
approves.
Medicare carrier: A private company that contracts with Medicare.
Medicare Select: A type of MedSup policy that may require you to use hospitals and doctors in
a network for the plan to pay its full share.
MedSup open enrollment period: A onetime- only six month period when you can buy
any MedSup policy offered in Ohio. It starts when you sign up for Medicare Part B at age
65 or older. You cannot be denied coverage or charged more due to past or present health
problems when you apply during this period.
MedSup policy: Medicare supplement insurance. MedSup is sold by private insurance
companies to fill coverage gaps in Original Medicare. The 10 standardized plans, named
Plan A through Plan J, work only with the Original Medicare Plan.
Original Medicare: A fee-for-service health plan that lets you go to any doctor, hospital or
other provider accepting Medicare. You may first owe a deductible for services under Part A
(hospital insurance) or Part B (medical insurance). Medicare pays most of its approved
amount for your services; you are responsible for your portion (usually 20 percent).
Skilled nursing care: A level of care given by Registered Nurses. Examples include giving
intravenous injections, tube feeding, supplying oxygen to help you breathe and changing sterile
dressings on a wound. Any service that could be done safely by an average non-medical
person — or one’s self — and without the supervision of a Registered Nurse is not
considered skilled care.
Skilled Nursing Facility: A facility with the staff and equipment to give skilled nursing care
and / or skilled rehabilitation services and other related health services.