Hot Words

Question 1

Member

Answer 1

Eligible and enrolled in WellCare

Question 2

Beneficiary

Answer 2

Eligible to participate in a medicare and/or medicaid program

Question 3

Medicare

Answer 3

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

Question 4

Medicaid

Answer 4

A joint federal and state program that helps with the medical costs for some individuals with low income and little resources

Question 5

PDP

Answer 5

Prescription Drug Plan

Question 6

Dual Eligible

Answer 6

Beneficiary covered by both medicare and medicaid

Question 7

Formulary

Answer 7

List of prescription under Part D (Prescription Drug Plan)

Question 8

Premium

Answer 8

Monthly payment for health coverage

Question 9

Deductible

Answer 9

The amount the member must pay before WellCare begins to pay

Question 10

Co-Payment or Co-Pay

Answer 10

The amount a member may pay for each prescription based on its plan. It is usually a set amount paid.

Question 11

Co-Insurance

Answer 11

A kind of cost-sharing where costs are split on a percentage basis.

Question 12

Coverage Limit

Answer 12

The maximum dollar amount a beneficiary can reach before they can have the coverage gap.

Question 13

Coverage Gap

Answer 13

A lag or hole in the coverage. Also known as “donut hole”

Question 14

TrOOP

Answer 14

True Out of Pocket Costs

Question 15

Subsidy

Answer 15

Financial assistance granted by the government

Question 16

Generic Drugs

Answer 16

Prescription drugs that have the same ingredient formula as a brand drug. Generic usually costs less than Brand drugs.

Question 17

Brand Name Drugs

Answer 17

Prescription drugs that are sols under a trademark brand name.

Question 18

Fraud

Answer 18

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).

Question 19

Abuse

Answer 19

Any practice inconsistent with sound financial, business, or generallg accepted medical practice.

Question 20

Benefits

Answer 20

Coverage that they may have with the plan (Part A, B, C, and D)