Medicare Terms – E

Effective Date

An effective date is the date in which your insurance coverage begins. Insurance providers will not pay for benefits incurred before the effective date.

Emergency Care

Care needed immediately because of a medical condition of sudden and unexpected onset.

End-Stage Renal Disease (ESRD)

Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

Enrollee

This is a member of a Medicare plan.

Evidence of Coverage (EOC)

The EOC gives you detailed information on your plan’s coverage, costs and your rights and responsibilities as a plan member.

Exception

A type of Medicare prescription drug coverage determination. A formulary exception is a drug plan’s decision to cover a drug that’s not on its drug list or to waive a coverage rule. A tiering exception is a drug plan’s decision to charge a lower amount for a drug that’s on its non-preferred drug tier. You or your prescriber must request an exception, and your doctor or other prescriber must provide a supporting statement explaining the medical reason for the exception.

Excess Charge

If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.

Explanation of Benefits (EOB)

Explanation of benefits statements are a document you will receive from your insurance company outlines the cost of the medical care your received. It outlines what costs will be covered by your insurance provider and what costs, if any that you are responsible for paying.

Extra Help

A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.