Medicare & Medicaid

Medicare & Medicaid

Medical insurance programs administered by the U.S. federal government that provide health care coverage for the elderly (people over 65) and certain people and families with low incomes and resources.

Industry: Insurance

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Medicare & Medicaid

Quality assurance

Insurance; Medicare & Medicaid

The process of looking at how well a medical service is provided. The process may include formally reviewing health care given to a person, or group of persons, locating the problem, correcting the ...

Implementation guide

Insurance; Medicare & Medicaid

A document explaining the proper use of a standard for a specific business purpose. The X12N HIPAA IGs are the primary reference documents used by those implementing the associated transactions, and ...

A tier

Insurance; Medicare & Medicaid

Is a specific list of drugs. Your plan may have several tiers,and your copayment amount depends on which tier your drug is listed.Plans can choose their own tiers, so members should refer to their ...

Morbidity

Insurance; Medicare & Medicaid

A diseased state, often used in the context of a "morbidity rate" (i.e. The rate of disease or proportion of diseased people in a population). In common clinical usage, any disease state, including ...

Inappropriate utilisation

Insurance; Medicare & Medicaid

Utilisation of services that are in excess of a beneficiary's medical needs and condition (overutilization) or receiving a capitated Medicare payment and failing to provide services to meet a ...

Actuarial rates

Insurance; Medicare & Medicaid

One half of the expected monthly cost of the SMI programme for each aged enrollee (for the aged actuarial rate) and one half of the expected monthly cost for each disabled enrollee (for the disabled ...

Premium surcharge

Insurance; Medicare & Medicaid

The standard Medicare Part B premium will go up ten percent for each full 12-month period (beginning with the first month after the end of your Initial Enrollment Period) that you could have had ...