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Medicare Terminology

Helping Ohioans Understand Medicare

Here at the Law Office of Margaret H. Kreiner, I focus exclusively on elder care law and estate planning. I help older clients and their families who are struggling to help.

How will we pay for nursing home care for an aging parent? What will happen to the assets Mom and Dad have worked so hard to build? Are there any insurance options available to middle class families?

The goal of my firm is to help families address these needs for the most positive outcome. Contact me for a confidential consultation with a skilled Medicare and Medicaid attorney.

Medicare Terminology

I have included the following Medicare definitions to help you become more informed about Medicare and Medicare drug coverage:

Co-pay or co-payment – A fixed fee that subscribers to a medical plan must pay for their use of specific medical services covered by the plan.

Deductible – This is an amount contained in a clause of an insurance policy that relieves the insurance company or Medicare for an initial loss of the kind insured against. This amount is the responsibility of the person covered under the policy.

Federal poverty level – These are poverty guidelines issued each year by the Department of Health and Human Services. They are used for administrative purposes including determination of financial eligibility for certain federal programs.

Formulary – This is a list of prescription medications for which a plan will provide coverage.

Medigap policy – This is health insurance that pays for some of your costs in the original Medicare Program and for some care which it does not cover. It is informally called the "Doughnut Hole." If you are covered by a Medicare + Choice Plan, you don’t need a Medigap policy.

Medicaid – This is a program that pays for medical assistance for certain persons and families with low incomes and resources. This program is jointly funded by federal and state governments. The program includes medical long-term care assistance and assistance to low-income pregnant women and poor children.

Medicare – Medicare is the national health insurance program for the following individuals:

  • Persons age 65 and older
  • Some persons under age 65 with disabilities
  • Persons with end stage renal disease (ESRD) which is permanent kidney failure and requires either dialysis or kidney transplantation

Medicare Part A – This is the Medicare program that pays for hospital and related services. It also covers limited stays in nursing homes, home health care, hospice care, inpatient psychiatric care, and blood transfusions. It does not pay for assisted living facilities, but may cover the costs of some services such as home health care and doctor visits.

Medicare Part B – This is the Medicare program that pays for some outpatient hospital and mental health services, doctor services (not routine physical exams, but many preventive screenings), laboratory fees, and medical equipment.

Medicare Part D – This is a Medicare plan which provides coverage for prescription drugs for eligible persons. This program begins January 1, 2006.

For a confidential consultation about Medicare drug coverage and additional elder law issues, contact the skilled lawyer at the Law Office of Margaret H. Kreiner in Cuyahoga Falls, Ohio.

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Margaret H. Kreiner

2020 Front Street, Suite 202
Cuyahoga Falls, OH 44221-3200
Phone: 330-331-5174
Toll Free: 866-476-5996
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