Medicare Terms

Explaining Terms used in Medicare

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Activities of Daily Living (ADLs)

Activities of Daily Living (ADLs) are basic tasks that must be accomplished every day for an individual to thrive. Generally, ADLs can be broken down into the following categories:

  • Personal hygiene
    Bathing, grooming, oral, nail, and hair care
  • Continence management
    A person’s mental and physical ability to properly use the bathroom
  • Dressing
    A person’s ability to select and wear the proper clothes for different occasions
  • Feeding
    Whether a person can feed themselves or needs assistance
  • Ambulating
    The extent of a person’s ability to change from one position to the other and to walk independently

Additional Benefits

Some benefits not covered by Medicare, such as travel to a foreign country, are covered by some Medicare supplement insurance plans. When looking at Medicare supplement insurance plans, be sure to find out if the plan offers the additional benefits you need.

Admitted (Hospital)

Hospital admission of a Covered Person to a Hospital as an Inpatient for Medically Necessary and Appropriate care and treatment of an Illness or Injury.

Advance Beneficiary Notice of Noncoverage (ABN)

In Original Medicare, a notice that a doctor, supplier, or provider gives a person with Medicare before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment. In this situation, if you aren’t given an ABN before you get the item or service, and Medicare denies payment, then you may not have to pay for it. If you are given an ABN, and you sign it, you’ll probably have to pay for the item or service if Medicare denies payment.

Advance Directive

A written document stating how you want medical decisions to be made if you lose the ability to make them for yourself. It may include a living will and a durable power of attorney for health care.

After Gap

If your annual costs hit a certain limit, you enter this phase and will only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

ALS

Amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.

Annual Enrollment Period (AEP) 

If you’re a Medicare member, this is a set time when you can change your health or drug plan, or switch to Original Medicare. The Annual Enrollment Period is from October 15 until December 7. Also, see “Medicare Open Enrollment Period”

Appeal

An appeal is the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan. You can appeal if Medicare or your plan denies one of these:

  • Your request for a health care service, supply, item, or prescription drug that you think you should be able to get
  • Your request for payment for a health care service, supply, item, or prescription drug you already got
  • Your request to change the amount you must pay for a health care service, supply, item, or prescription drug.

You can also appeal if Medicare or your plan stops providing or paying for all or part of a service, supply, item, or prescription drug you think you still need

Assignment

An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.