Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
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- FQHC
- FSA
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- Medicaid (rare)
- Medicaid expansion
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- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
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- NCD
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- NOMNC
- Original Medicare
- PCP
- Part A
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- Part C
- Part D
- QLE
- QMB
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- Section 1115
- Silver Plan
- Silver plan
Brand-name Drugs
Prescription drugs sold under a trademark-protected brand name, typically more expensive than generic drugs. Covered under programs like Medicare Part D, Medicaid, and CHIP.
Prescription drugs sold under a trademark-protected brand name, typically more expensive than generic drugs. Covered under programs like Medicare Part D, Medicaid, and CHIP.
Coverage Gap (Donut Hole)
A temporary limit on what Medicare Part D will cover for prescription drugs. After reaching a certain spending threshold, beneficiaries may pay more out-of-pocket for prescriptions until they reach the catastrophic coverage phase.
A temporary limit on what Medicare Part D will cover for prescription drugs. After reaching a certain spending threshold, beneficiaries may pay more out-of-pocket for prescriptions until they reach the catastrophic coverage phase.
Catastrophic Coverage (Medicare Part D)
The phase of Medicare Part D coverage that begins after a beneficiary has spent a specified amount on prescription drugs during the year. During this phase, Medicare covers most prescription drug costs, and the beneficiary pays only a small copayment or coinsurance.
The phase of Medicare Part D coverage that begins after a beneficiary has spent a specified amount on prescription drugs during the year. During this phase, Medicare covers most prescription drug costs, and the beneficiary pays only a small copayment or coinsurance.
Donut Hole (Coverage Gap)
The temporary limit on prescription drug coverage under Medicare Part D. During this phase, beneficiaries may pay a higher percentage of drug costs until they reach the threshold for catastrophic coverage.
The temporary limit on prescription drug coverage under Medicare Part D. During this phase, beneficiaries may pay a higher percentage of drug costs until they reach the threshold for catastrophic coverage.
Drug Formulary
A list of prescription medications covered by a health insurance plan, such as Medicare Part D or CHIP. Medications on the formulary are categorized into tiers, with different levels of cost-sharing for generic, brand-name, and specialty drugs.
A list of prescription medications covered by a health insurance plan, such as Medicare Part D or CHIP. Medications on the formulary are categorized into tiers, with different levels of cost-sharing for generic, brand-name, and specialty drugs.
Extra Help (Medicare Part D)
A federal program that helps individuals with limited income and resources pay for the costs of prescription drugs under Medicare Part D. Extra Help covers premiums, deductibles, and copayments for eligible beneficiaries.
A federal program that helps individuals with limited income and resources pay for the costs of prescription drugs under Medicare Part D. Extra Help covers premiums, deductibles, and copayments for eligible beneficiaries.
Formulary
A list of prescription medications that are covered by a health insurance plan, such as Medicare Part D or CHIP. Drugs listed on a formulary are usually divided into tiers, with different levels of cost-sharing based on the type of drug (generic, brand-name, or specialty).
A list of prescription medications that are covered by a health insurance plan, such as Medicare Part D or CHIP. Drugs listed on a formulary are usually divided into tiers, with different levels of cost-sharing based on the type of drug (generic, brand-name, or specialty).
Formulary Tiers
Categories within a drug formulary that determine the level of coverage and cost-sharing for medications. Typically, Tier 1 includes generic drugs with the lowest copays, while higher tiers include brand-name and specialty drugs with higher costs.
Categories within a drug formulary that determine the level of coverage and cost-sharing for medications. Typically, Tier 1 includes generic drugs with the lowest copays, while higher tiers include brand-name and specialty drugs with higher costs.
Generic Drugs
Medications that contain the same active ingredients as brand-name drugs but are sold at lower prices. Medicare Part D, Medicaid, and CHIP often cover generic drugs to reduce costs for beneficiaries.
Medications that contain the same active ingredients as brand-name drugs but are sold at lower prices. Medicare Part D, Medicaid, and CHIP often cover generic drugs to reduce costs for beneficiaries.
Low-Income Subsidy (LIS)
A federal program that helps Medicare Part D beneficiaries with limited income and resources pay for prescription drug costs. The LIS program covers premiums, deductibles, and copayments for eligible individuals, reducing out-of-pocket expenses.
A federal program that helps Medicare Part D beneficiaries with limited income and resources pay for prescription drug costs. The LIS program covers premiums, deductibles, and copayments for eligible individuals, reducing out-of-pocket expenses.
Medicare Part D
The prescription drug coverage component of Medicare, available through private plans. Part D helps beneficiaries pay for the cost of prescription medications, with cost-sharing determined by drug formularies and tier levels.
The prescription drug coverage component of Medicare, available through private plans. Part D helps beneficiaries pay for the cost of prescription medications, with cost-sharing determined by drug formularies and tier levels.
Part D (Medicare)
Prescription drug coverage for Medicare beneficiaries, offered by private insurance plans. Part D helps cover the cost of prescription drugs and has a formulary, or list of covered medications, categorized by cost tiers.
Prescription drug coverage for Medicare beneficiaries, offered by private insurance plans. Part D helps cover the cost of prescription drugs and has a formulary, or list of covered medications, categorized by cost tiers.
Prescription Drug Coverage
Health insurance coverage that helps pay for the cost of prescription medications. Medicare Part D, Medicaid, CHIP, and many ACA Marketplace plans offer prescription drug coverage.
Health insurance coverage that helps pay for the cost of prescription medications. Medicare Part D, Medicaid, CHIP, and many ACA Marketplace plans offer prescription drug coverage.
Tiered Drug Formulary
A system used by health insurance plans to categorize prescription drugs into different cost tiers, with generic drugs typically in the lowest tier and specialty or brand-name drugs in higher tiers. Medicare Part D and ACA plans often use a tiered formulary system.
A system used by health insurance plans to categorize prescription drugs into different cost tiers, with generic drugs typically in the lowest tier and specialty or brand-name drugs in higher tiers. Medicare Part D and ACA plans often use a tiered formulary system.
Zoster (Shingles) Vaccine
A vaccination to protect against shingles, a painful rash caused by the reactivation of the chickenpox virus. Medicare Part D and some Medicaid programs cover the shingles vaccine, while ACA Marketplace plans include vaccinations as part of preventive services.