What is a Deductible?

by Doug Benson September 10, 2011

A deductible is the portion of coverage not covered by the insurance provider. Deductibles are normally quoted as a fixed amount. The deductible must usually be paid first before the insurance starts paying. Deductibles can be annual or a per-service. An example of an annual deductible is the Medicare Part B deductible – $140 for […]

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What is Durable Medical Equipment?

by Doug Benson July 10, 2011

Medicare covers things like wheelchairs, walkers, oxygen equipment, hospital beds etc. that are ordered by a doctor or other health provider to be used at home. Some of these items are rented and some are purchased. You must get these items from Medicare approved providers. Unlike other services under Part-B, Durable Medical Equipment does not […]

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What are Co-Pays?

by Doug Benson June 10, 2011

Co-pays or Co-payments are the portion of the co-insurance that you pay. Most Medicare Advantage plans and some Medicare Supplements have co-pays associated with every medical service. For example a visit to a primary physician might have a $20 co-pay. The co-pay for an outpatient procedure might be $100 or 20% of the cost of […]

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What are Out of Pocket expenses?

by Doug Benson May 10, 2011

Out-of-pocket expenses are the expenses that YOU pay out of your pocket. Out-of-pocket expenses  include premiums, deductibles and co-pays. Generally this term is used when describing Medicare Advantage plans or Prescription Drug plans.

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What is Co-Insurance?

by Doug Benson April 10, 2011

Co-Insurance is the “splitting up” of the cost of Medical Coverage. The insurance company (or plan) pays some of the cost,  the insured (you) pay some and sometimes a third party will pay as well. The part that you pay can be via a deductible and/or co-pays. Medicare is a Co-insurance plan. For example, if […]

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What is Extra Help?

by Doug Benson March 10, 2011

Extra Help is a program to help people with limited income and resources pay for their prescription drugs. It is also known as the “Low-income subsidy” or LIS. There is a page of requirements in your Medicare and You book. The income and resource limits change every year. The 2012 yearly income limit for an […]

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What is an Exess Charge?

by Doug Benson February 10, 2011

The amount over what Medicare approves. Doctors and healthcare providers who do not accept assignment can charge up to 15% more than the Medicare approved amount for services. Some Medicare Supplement Plans cover these excess charges if they occur. Some Medicare Supplements will pay any excess charge and some will not. Most healthcare providers accept Medicare On […]

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What is Medicare Assignment?

by Doug Benson November 20, 2010

Assignment is an agreement between you, Medicare, and your doctor or other healthcare provider. You “assign” Medicare to pay your doctor or healthcare provider directly for their services. Most doctors, and healthcare providers accept assignment. If they do not accept assignment, they are allowed to charge you more than the Medicare Approved amount. But they […]

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What is the Donut Hole, Gap, Coverage Gap

by Doug Benson November 10, 2010

Also Known As The Gap, Coverage Gap, and several four-letter words 🙂 Donut Hole, Coverage Gap, The Gap – Most Part-D plans have a coverage gap, which is usually referred to as the “donut hole.” This is a confusing aspect to the Part-D plans that many people have never had explained properly. How does the […]

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