Your new coverage will begin January 1.

APPROVED AMOUNT- The fee that Medicare sets as its rate for a medical service.

If you are in the Original Medicare Plan, it can save you money if your doctor accepts assignment.

You still pay your share of the cost of the doctor’s visit.

BENEFICIARY- A person who has health care insurance through the Medicare or Medicaid program.

You must pay the inpatient hospital deductible for each benefit period.

There is no limit to the number of benefit periods.

Some examples of chronic illnesses include Alzheimers disease, arthritis and diabetes.

COINSURANCE- The amount you may be required to pay for services after you pay any plan deductibles.

You have to pay this amount after you pay the deductible for Part A and/or Part B.

In a Medicare Prescription Drug Plan, the coinsurance will vary depending on how much you have spent.

A copayment is usually a set amount you pay.

For example, this could be $10 or $20 for a doctors visit or prescription.

Copayments are also used for some hospital outpatient services in the Original Medicare Plan.

COST SHARING- Any out-of-pocket payment the patient makes for a portion of the costs of covered services.

Deductibles, coinsurance, copayments and balance bills are types of cost sharing.

COST TIERS- A system that drug plans use to price medications.

COVERAGE GAP- Also called a Doughnut Hole.

It may also include care that most people do themselves, like using eye drops.

In most cases, Medicare doesnt pay for custodial care.

These amounts can change every year.

DOUGHNUT HOLE- See Coverage Gap.

DRUG CLASS- A group of drugs that treat the same symptoms or have similar effects on the body.

DRUG LIST- A list of drugs covered by a plan.

This list is also called a formulary.

DUAL ELIGIBLE- A person who has both Medicare and Medicaid.

To be covered by Medicare, durable medical equipment must be prescribed by a doctor.

Many types of adaptive equipment are not covered.

ELECTION / ENROLLMENT PERIODS- The times when a Medicare-eligible person can choose to join or leave a Medicare plan.

It is not a bill.

The FPL is used in eligibility criteria of many programs, including Extra Help and Medicaid.

The FPL changes every year and varies depending on the number of people in your household.

It is higher in Alaska and Hawaii.

FORMULARY- A list of drugs covered by a plan.