Exception
What is a Medicare Part D Exception? An exception in a Medicare Part D plan is a type of prescription drug coverage determination. You must…
Topic: Glossary
End-Stage Renal Disease
What is End-Stage Renal Disease (ESRD)? End-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or…
Durable Medical Equipment
What is Durable Medical Equipment? Durable medical equipment (DME), also known as DMEPOS (Durable medical equipment, Prosthetics, and Supplies), is designed to last and can…
Formulary
What is a Drug Formulary? A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription…
Custodial Care
What is Custodial Care in Medicare? Custodial Care is non-skilled personal care, such as helping with activities of daily living like bathing, dressing, eating, getting…
Creditable Coverage
What is Medicare Creditable Coverage? Creditable coverage refers to health insurance or prescription drug benefits that meet Medicare’s minimum qualifications necessary to avoid a penalty.…
Coverage Gap
What is the Medicare Part D Coverage Gap? The Medicare Part D coverage gap, also known as the donut hole, is one of the four…
Coverage Determination
What is a Medicare Part D Coverage Determination? A coverage determination is the first decision made by a Medicare Part D plan (not the pharmacy)…
Cost Sharing
What is Medicare Cost Sharing? Medicare’s cost-sharing is the out-of-pocket costs that beneficiaries pay to receive medical services or supplies, like a doctor’s visit, hospital…
Coordination of Benefits
What is Coordination of Benefits in Medicare? Coordination of Benefits is a way to determine who pays first when two or more health insurance plans…