Interactive Glossary - Section G-I
A-C D-F G-I J-L M-O P-R S-U V-W X-Z
G
Gaps in Coverage: Services or costs that are not covered under the Original Medicare health insurance plan, such as prescription drugs, deductibles, and coinsurance.
Gatekeeper: In a managed care plan your primary care physician (PCP), who oversees your care and decides when to refer you to a specialist.
General Enrollment Period: The time period between January 1 and March 31 of every year when you can enroll in Medicare Part B for the first time. If you enroll during this period (and it is after your Initial Enrollment Period), your coverage will begin on July 1.
Generic Drug: A copy of a brand-name drug that is regulated by the Food and Drug Administration to be identical in dosage, safety, strength, how it is taken, quality, performance and intended use (Definition from the U.S. Food and Drug Administration). Generics generally work just as well as the brand-name version but are cheaper because they are not patented.
Grievance: A complaint or dispute filed with your Medicare private health plan (Part C) orMedicare private drug plan (Part D) about any part of the plan’s operations, behavior or activities. You must file a grievance orally or in writing within 60 days of the event or incident. For example, you may file a grievance if you are dissatisfied with the condition of a health care facility or the facility’s operating hours, or if you have a complaint about the behavior of those working for the facility or the private health or drug plan, itself. An appeal, not a grievance, is the appropriate way to complain about a denial of coverage. However, Medicare private health plans and drug plans must respond to grievances within 24 hours if they involve the plan’s failure to grant an expedited appeal (and in the case of a drug plan, you have not yet purchase the medication). A Medicare drug plan must notify you of its decision about other grievances within 30 days of receiving them (but can extend that time up to 14 calendar days). There are no similar deadlines for Medicare private health plans.
Group Health Plan: Employer or union-based health insurance administered to current or former employees of a company or organization through a private insurance company. This insurance may be primary or secondary to Medicare coverage depending on the size of the company and whether or not you are currently working.
Guaranteed Issue: A consumer protection that gives people the right to buy Medigapsupplemental insurance. Because of this right, which is in effect during certain times, an insurance company cannot deny you insurance coverage or place conditions on a policy, must cover your pre-existing conditions, and cannot charge you more for a policy because of your health status.
H
Health Care Financing Administration (HCFA): See Centers for Medicare and Medicaid Services (CMS).
Health Care Provider: An individual or facility, such as a doctor or hospital, which provides health care services. (See also Provider.)
Health Care Power of Attorney: Legal document that lets you (“the principal”) appoint another person(s) (your “agent” or “attorney in fact”) to make health care decisions for you if you become too sick or disabled to make them yourself. State law determines whether Medicareplan enrollment is a health care decision that your health care agent can carry out for you.
Health Care Proxy: Legal document that allows you to appoint another person (a “proxy” or “agent”) to make health care decisions for you if you can not speak for yourself.
Hill-Burton Program/Facilities: Hospitals and clinics that offer free or reduced-cost care to patients who meet qualifying income limits. These vary in what types of services they offer and do not provide services that are covered by a patient's insurance.
Health Insurance: Insurance that protects you against loss from illness, generally through compensation for medical expenses. Programs like Medicare and Medicaid are government-sponsored forms of health insurance. Health insurance can also be administered by private companies that offer individual policies, group health plans, and supplemental insurance. Medicare private health plans (Part C) and Medicare private drug plans (Part D) are examples of government-sponsored health insurance that is administered by private companies.
Hill-Burton Program/Facilities: Hospitals and clinics that offer free or reduced-cost care to patients who meet qualifying income limits. These vary in what types of services they offer and do not provide services that are covered by a patient's health insurance.
HIPAA: Amended the Employee Retirement Income Security Act (ERISA), to provide new rights and protections for members of group health plans. HIPAA contains protections both for health coverage offered in connection with employment (group health plans) and forindividual insurance policies sold by insurance companies.
HMO (Health Maintenance Organization): A type of managed care plan that generally covers only the care you get from providers that are in the HMO’s network. People with Medicare can choose to get their Medicare benefits through an HMO. HMO members must choose aprimary care physician (PCP) who coordinates their care and acts as a gatekeeper to their care. See also, Part C.
Homebound: The state of having a condition such that there exists a normal inability to leave home and leaving home requires "a considerable and taxing effort.” A person does not have to be confined to bed to be considered homebound by Medicare. Leaving home for short periods of time for special non-medical events such as a family reunion, funeral or graduation would not exclude someone from being considered homebound. A doctor must certify this condition.
Home Health Agency: An organization that provides home care services, such as skilled nursing, physical therapy, occupational therapy, speech/language pathology, and personal care.
Home Health Aide: A worker who helps a patient at home with activities of daily living.Medicare does not pay separately for aides to perform custodial care, but they may do light housekeeping related to personal care during the visit. Medicare will not pay for home health aide services unless they are accompanied by a need for skilled care.
Home Health Care: Care provided at home to treat an illness or injury. Medicare will only cover care in the home if the person has a need for skilled care.
Homemaking Services: See Custodial Care.
Hospice: Comprehensive care for people who are terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient care and outpatient care, and services for the terminally ill person's family.
Hospital Insurance: See Part A.
Hospital-Issued Notice of Non-Coverage (HINN): A written notice which explains:
Housekeeping Services: See Custodial Care.
I
Important Message from Medicare: A notice given to you by the hospital whether you are inOriginal Medicare or in a Medicare private health plan when you are going to be dischargedthat explains your rights as a patient. It also tells you how to ask for an expedited review of the discharge decision by the Quality Improvement Organization (QIO). This is the same document you should have been asked to sign within two days of being admitted to the hospital.
Independent Review Entity (IRE): An independent entity with which Medicare contracts to handle the second level of appeals of a denial of coverage (except for of hospital care) if you are in a Medicare private health plan (Part C) or Medicare private drug plan (Part D).
Individual Policy: A private health plan that covers an individual person as opposed to a group (such as a group of employees covered by an employer group health plan). It is separate from Medicare coverage.
Initial Coverage Election Period: A period of time that begins the three months immediately before you are entitled to Medicare Part A and enrolled in Part B and ends either the last day of the month before you are entitled to Part A and enrolled in Part B or three months after the month of your 65th birthday or the 25th month of receiving Social Security Disability Insurance (SSDI). If you choose to join a Medicare private health plan (Part C) during this period, the plan must accept you, unless it has reached its member limit.
Initial Enrollment Period: The first chance you have to enroll in Part A, Part B or Part D if you do not get it automatically. If you enroll during this time, which begins three months before you first meet the eligibility requirements for Medicare and continues for seven months, you do not pay a premium penalty.
Initial Open Enrollment Period: A six month period beginning the month you enroll in Part Bduring which you can buy any Medigap supplemental insurance plan you want. If you are 65 or older, you are guaranteed this enrollment period in all states. Only a few states extend this enrollment period to people who are under 65. If you enroll during this time, the insurance company cannot
Inpatient Care: Care that you get when you are in the hospital overnight.
Intermediate Care Facility for the Mentally Retarded (ICF/MR): A skilled nursing facilityspecifically designed to provide “active treatment” to people with mental retardation.
Intermediary: See Fiscal Intermediary.
Fiscal Intermediary> Also known as an “Intermediary.” A private company that has a contract with Medicare to process Medicare Part A claims.
Formulary: The list of prescription drugs for which a Medicare private health plan (Part C) that offers drug coverage—Medicare Advantage Prescription Drug Plan (MA-PD)—or aMedicare private drug plan (Part D) will help pay. Drugs not on the formulary are generally not covered by private plans.
Formulary Restrictions: See Coverage Restrictions.
Free Look: A period of time when you can try out a Medicare supplemental insurance(Medigap) policy. During this time (usually 30 days), you can cancel the policy and get a full refund.
Gaps in Coverage: Services or costs that are not covered under the Original Medicare health insurance plan, such as prescription drugs, deductibles, and coinsurance.
Gatekeeper: In a managed care plan your primary care physician (PCP), who oversees your care and decides when to refer you to a specialist.
General Enrollment Period: The time period between January 1 and March 31 of every year when you can enroll in Medicare Part B for the first time. If you enroll during this period (and it is after your Initial Enrollment Period), your coverage will begin on July 1.
Generic Drug: A copy of a brand-name drug that is regulated by the Food and Drug Administration to be identical in dosage, safety, strength, how it is taken, quality, performance and intended use (Definition from the U.S. Food and Drug Administration). Generics generally work just as well as the brand-name version but are cheaper because they are not patented.
Grievance: A complaint or dispute filed with your Medicare private health plan (Part C) orMedicare private drug plan (Part D) about any part of the plan’s operations, behavior or activities. You must file a grievance orally or in writing within 60 days of the event or incident. For example, you may file a grievance if you are dissatisfied with the condition of a health care facility or the facility’s operating hours, or if you have a complaint about the behavior of those working for the facility or the private health or drug plan, itself. An appeal, not a grievance, is the appropriate way to complain about a denial of coverage. However, Medicare private health plans and drug plans must respond to grievances within 24 hours if they involve the plan’s failure to grant an expedited appeal (and in the case of a drug plan, you have not yet purchase the medication). A Medicare drug plan must notify you of its decision about other grievances within 30 days of receiving them (but can extend that time up to 14 calendar days). There are no similar deadlines for Medicare private health plans.
Group Health Plan: Employer or union-based health insurance administered to current or former employees of a company or organization through a private insurance company. This insurance may be primary or secondary to Medicare coverage depending on the size of the company and whether or not you are currently working.
Guaranteed Issue: A consumer protection that gives people the right to buy Medigapsupplemental insurance. Because of this right, which is in effect during certain times, an insurance company cannot deny you insurance coverage or place conditions on a policy, must cover your pre-existing conditions, and cannot charge you more for a policy because of your health status.
H
Health Care Financing Administration (HCFA): See Centers for Medicare and Medicaid Services (CMS).
Health Care Provider: An individual or facility, such as a doctor or hospital, which provides health care services. (See also Provider.)
Health Care Power of Attorney: Legal document that lets you (“the principal”) appoint another person(s) (your “agent” or “attorney in fact”) to make health care decisions for you if you become too sick or disabled to make them yourself. State law determines whether Medicareplan enrollment is a health care decision that your health care agent can carry out for you.
Health Care Proxy: Legal document that allows you to appoint another person (a “proxy” or “agent”) to make health care decisions for you if you can not speak for yourself.
Hill-Burton Program/Facilities: Hospitals and clinics that offer free or reduced-cost care to patients who meet qualifying income limits. These vary in what types of services they offer and do not provide services that are covered by a patient's insurance.
Health Insurance: Insurance that protects you against loss from illness, generally through compensation for medical expenses. Programs like Medicare and Medicaid are government-sponsored forms of health insurance. Health insurance can also be administered by private companies that offer individual policies, group health plans, and supplemental insurance. Medicare private health plans (Part C) and Medicare private drug plans (Part D) are examples of government-sponsored health insurance that is administered by private companies.
Hill-Burton Program/Facilities: Hospitals and clinics that offer free or reduced-cost care to patients who meet qualifying income limits. These vary in what types of services they offer and do not provide services that are covered by a patient's health insurance.
HIPAA: Amended the Employee Retirement Income Security Act (ERISA), to provide new rights and protections for members of group health plans. HIPAA contains protections both for health coverage offered in connection with employment (group health plans) and forindividual insurance policies sold by insurance companies.
HMO (Health Maintenance Organization): A type of managed care plan that generally covers only the care you get from providers that are in the HMO’s network. People with Medicare can choose to get their Medicare benefits through an HMO. HMO members must choose aprimary care physician (PCP) who coordinates their care and acts as a gatekeeper to their care. See also, Part C.
Homebound: The state of having a condition such that there exists a normal inability to leave home and leaving home requires "a considerable and taxing effort.” A person does not have to be confined to bed to be considered homebound by Medicare. Leaving home for short periods of time for special non-medical events such as a family reunion, funeral or graduation would not exclude someone from being considered homebound. A doctor must certify this condition.
Home Health Agency: An organization that provides home care services, such as skilled nursing, physical therapy, occupational therapy, speech/language pathology, and personal care.
Home Health Aide: A worker who helps a patient at home with activities of daily living.Medicare does not pay separately for aides to perform custodial care, but they may do light housekeeping related to personal care during the visit. Medicare will not pay for home health aide services unless they are accompanied by a need for skilled care.
Home Health Care: Care provided at home to treat an illness or injury. Medicare will only cover care in the home if the person has a need for skilled care.
Homemaking Services: See Custodial Care.
Hospice: Comprehensive care for people who are terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient care and outpatient care, and services for the terminally ill person's family.
Hospital Insurance: See Part A.
Hospital-Issued Notice of Non-Coverage (HINN): A written notice which explains:
- That Original Medicare probably will not cover your hospital stay;
- What you will have to pay if you decide to go ahead with your care anyway; and
- Your rights to an immediate QIO appeal of the hospital’s decision.
Housekeeping Services: See Custodial Care.
I
Important Message from Medicare: A notice given to you by the hospital whether you are inOriginal Medicare or in a Medicare private health plan when you are going to be dischargedthat explains your rights as a patient. It also tells you how to ask for an expedited review of the discharge decision by the Quality Improvement Organization (QIO). This is the same document you should have been asked to sign within two days of being admitted to the hospital.
Independent Review Entity (IRE): An independent entity with which Medicare contracts to handle the second level of appeals of a denial of coverage (except for of hospital care) if you are in a Medicare private health plan (Part C) or Medicare private drug plan (Part D).
Individual Policy: A private health plan that covers an individual person as opposed to a group (such as a group of employees covered by an employer group health plan). It is separate from Medicare coverage.
Initial Coverage Election Period: A period of time that begins the three months immediately before you are entitled to Medicare Part A and enrolled in Part B and ends either the last day of the month before you are entitled to Part A and enrolled in Part B or three months after the month of your 65th birthday or the 25th month of receiving Social Security Disability Insurance (SSDI). If you choose to join a Medicare private health plan (Part C) during this period, the plan must accept you, unless it has reached its member limit.
Initial Enrollment Period: The first chance you have to enroll in Part A, Part B or Part D if you do not get it automatically. If you enroll during this time, which begins three months before you first meet the eligibility requirements for Medicare and continues for seven months, you do not pay a premium penalty.
Initial Open Enrollment Period: A six month period beginning the month you enroll in Part Bduring which you can buy any Medigap supplemental insurance plan you want. If you are 65 or older, you are guaranteed this enrollment period in all states. Only a few states extend this enrollment period to people who are under 65. If you enroll during this time, the insurance company cannot
- deny you Medigap coverage or make you wait for coverage to start; or
- charge you more for a policy because of past or present health problems.
Inpatient Care: Care that you get when you are in the hospital overnight.
Intermediate Care Facility for the Mentally Retarded (ICF/MR): A skilled nursing facilityspecifically designed to provide “active treatment” to people with mental retardation.
Intermediary: See Fiscal Intermediary.
Fiscal Intermediary> Also known as an “Intermediary.” A private company that has a contract with Medicare to process Medicare Part A claims.
Formulary: The list of prescription drugs for which a Medicare private health plan (Part C) that offers drug coverage—Medicare Advantage Prescription Drug Plan (MA-PD)—or aMedicare private drug plan (Part D) will help pay. Drugs not on the formulary are generally not covered by private plans.
Formulary Restrictions: See Coverage Restrictions.
Free Look: A period of time when you can try out a Medicare supplemental insurance(Medigap) policy. During this time (usually 30 days), you can cancel the policy and get a full refund.
