Hot Words Flashcards
Member
Eligible and enrolled in WellCare
Beneficiary
Eligible to participate in a medicare and/or medicaid program
Medicare
The federal insurance program for:
- individuals 65 years’ old or above
- certain individuals under 65 years’ old with disabilities
- individuals with ESRD (End-stage Renal Disease)
- individuals with medicare-covered government employment
- individuals with Lou Gehrig’s Disease
Medicaid
A joint federal and state program that helps with the medical costs for some individuals with low income and little resources
PDP
Prescription Drug Plan
Dual Eligible
Beneficiary covered by both medicare and medicaid
Formulary
List of prescription under Part D (Prescription Drug Plan)
Premium
Monthly payment for health coverage
Deductible
The amount the member must pay before WellCare begins to pay
Co-Payment or Co-Pay
The amount a member may pay for each prescription based on its plan. It is usually a set amount paid.
Co-Insurance
A kind of cost-sharing where costs are split on a percentage basis.
Coverage Limit
The maximum dollar amount a beneficiary can reach before they can have the coverage gap.
Coverage Gap
A lag or hole in the coverage. Also known as “donut hole”
TrOOP
True Out of Pocket Costs
Subsidy
Financial assistance granted by the government
Generic Drugs
Prescription drugs that have the same ingredient formula as a brand drug. Generic usually costs less than Brand drugs.
Brand Name Drugs
Prescription drugs that are sols under a trademark brand name.
Fraud
The intentional deception or misinterpretation that an individual knows, or should know, to be false, or does nor believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s).
Abuse
Any practice inconsistent with sound financial, business, or generallg accepted medical practice.
Benefits
Coverage that they may have with the plan (Part A, B, C, and D)
