Glossary

Mail-Order Pharmacy (Mail-Order Drugs)

Health benefits plans often offer distribution of prescribed medication directly to the patient through the mail. Since mail-order distributors can purchase drugs in larger volumes than retail outlets, the cost charged to patients is often lower. Your health plan may have lower pharmacy copayments if you use mail-order drug delivery. Check with your health plan to see if mail order is available to you.

Managed Care

Any form of health benefits plan that actively monitors health care services received by covered individuals for effectiveness, cost efficiency and/or quality. Typical managed care plans provide a higher level of benefits for a select network of contracted providers and may require preauthorization of certain services.

Mandated Benefits

Benefits that health care plans are required to provide by state or federal law.

Medicaid

A State government program that provides health care insurance for low income people, including families and children.

Medical Savings Account (MSA or Archer MSA)

MSAs were tax-advantaged health savings accounts for individuals who are either employed by a small employer (fewer than 50 employees) or are self-employed. The MSA program was discontinued in 2003 with the authorization of Health Savings Accounts, which operate in a similar manner.

Medically Necessary

See Necessary, Medically Necessary, Medically Necessary Services or Medical Necessity

Medicare

A Federal government program that provides health care insurance to people aged 65 years or older, as well as to certain disabled people.

Medicare Advantage

Medicare Advantage is a health benefits plan provided by a carrier as an alternative to traditional Medicare Part A and Part B coverage. Medicare Advantage plans may provide additional benefits and/or different levels of coverage and may have different required contributions compared to traditional Medicare coverage.

Medicare Advantage Plan (also called Medicare Part C)

A Medicare program that gives you more choices among health plans and extends benefits beyond the Original Medicare Plan. It includes private Medicare Advantage plans (such as HMOs and PPOs) that provide Part A and B benefits to enrollees, as well as Medicare prescription drug benefits beginning in 2006. Nearly everyone with Medicare Parts A and B is eligible for a Medicare Advantage plan. Medicare Advantage plans previously were called Medicare+Choice plans.

Medicare Part A

A government supported health insurance plan that helps cover inpatient hospital care, care in nursing homes, hospice care and some home health care for qualified Americans age 65 and older and certain younger individuals with disabilities. Most people pay for Part A coverage through taxes while working and, therefore, do not pay a deductible or monthly premium.

Medicare Part B

A government supported health insurance plan that covers doctors' services, outpatient hospital care, medical equipment, physical and occupational therapy and some home health care for qualified Americans age 65 and older and certain younger individuals with disabilities. Most people pay an annual deductible and a monthly premium for this health plan.

Medicare Part C (also called Medicare Advantage Plan)

A Medicare program that gives you more choices among health plans and extends benefits beyond the Original Medicare Plan. It includes private Medicare Advantage plans (such as HMOs and PPOs) that provide Part A and B benefits to enrollees, as well as Medicare prescription drug benefits beginning in 2006. Nearly everyone with Medicare Parts A and B is eligible for a Medicare Advantage plan. Medicare Advantage plans previously were called Medicare+Choice plans.

Medicare Part D

A government supported health insurance plan that helps cover prescription drug costs for qualified individuals who are entitled to Medicare Part A and/or B. Beginning January 1, 2006, private health insurance companies have offered these plans to Medicare recipients.

Medicare Prescription Drug Coverage

Sometimes called Medicare Part D coverage, a plan of benefits provided under the Medicare program that contributes to the cost of prescription drugs.

Medigap

Insurance that supplements the reimbursement provided by Medicare for medical services. Medigap plans often pay for certain classes of services not covered by traditional Medicare coverage, and may also pay for co-insurance or other amounts seniors are required to contribute to their Medicare coverage.