Benefit Period ” The method by which Medicare measures your use of hospital and Skilled Nursing Facility (SNF) services. A benefit period begins the day you go to a hospital or SNF and ends when you haven’t received any hospital care (or skilled care in an SNF) for 60 days in a row. If you go into the hospital or an SNF after one benefit period has ended, a new benefit period begins if you are in the Original Medicare Plan. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you may have.
Custodial Care ” Non-skilled personal care, such as help with Activities of Daily Living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include care that most people do themselves, like using eye drops. Medicare does not pay for custodial care in most cases.
Medicare Program ” A health insurance program for those 65 or over, those under 65 with certain disabilities, and all those with End-Stage Renal Disease (permanent kidney failure).
Medicare Advantage Plan ” A type of Medicare health plan offered by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits. Also called “Part C.”
Medicare Part A (Hospital Insurance) ” Helps cover inpatient care in hospitals, including critical access hospitals, and Skilled Nursing Facilities (not custodial or long-term care). Also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Medicare Part B (Medical Insurance) ” Helps cover medically necessary items like doctors services, outpatient care, durable medical equipment, home health services, and other medical services. Also covers some preventive services. Check your Medicare Card to find out if you have Part B.
Medicare Part C (Medicare Advantage) “Plans such as an HMO or a PPO that provides another Medicare health plan choice you may have as part of Medicare. Sometimes called “Part C” or “MA Plans,” Medicare Advantage Plans are offered by private companies approved by Medicare. If you join such a plan, all of your Part A and Part B coverage will be provided. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare Prescription Drug Coverage (Part D).
Medicare Part D (Medicare Prescription Drug Coverage) ” For such coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Plans vary in cost and drugs covered.
Medicare Summary Notice (MSN) ” A notice received after the doctor or provider files a claim for Part A and Part B services in the Original Medicare Plan. It explains what the provider billed for, the Medicare-approved amount, how much Medicare paid, and what you are required to pay.
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Occupational Therapy ” Services provided to help you return to usual activities (such as bathing, preparing meals, and housekeeping) after illness, either on an inpatient or outpatient basis.
Original Medicare Plan “Has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). It’s a fee-for-service health plan in which you must pay the deductible. Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
Physical Therapy ” Treatment of injury and disease by mechanical means, such as heat, light, exercise, and massage.
Respite Care ” Short-term, temporary care that helps a caregiver who is responsible for the primary care of a loved one. Respite care allows caregivers to take time away from their responsibilities to rest and come back refreshed.
Speech-Language Pathology Services ” The study, examination, and treatment of defects and diseases of the voice, speech, and spoken and written language, as well as the use of appropriate substitution devices and treatment.
Skilled Nursing Facility Care ” A level of care requiring the daily involvement of a skilled nursing or rehabilitation staff. Examples of such care include intravenous injections and physical therapy. The need for custodial care (such as help with Activities of Daily Living (ADL’s), like bathing and dressing) cannot qualify for Medicare coverage in a Skilled Nursing Facility if it is the only care needed. However, if you qualify for coverage based on your need for skilled nursing care or rehabilitation, Medicare will cover all of your care needs in the facility, including help with ADL’s.
Skilled Nursing Facility (SNF) ” A nursing facility with the staff and equipment to provide skilled nursing care and/or skilled rehabilitation services and other related health services.