Updated: Sep 17, 2021
Medicare Glossary 聯邦醫療保險專業術語表
Understanding Medicare means understanding the meaning of many unfamiliar terms. The following is a list of words and acronyms that are used when discussing Medicare or are important to give you a better understanding of how Medicare works.
Affordable Care Act (also known as the Health Care Law)
The Affordable Care Act (ACA) includes provisions to expand health coverage to eligible Americans, control health care costs, and improve the health care delivery system. The ACA closes the Medicare Part D donut hole/coverage gap and expands coverage of preventive services for people with Medicare. The Act also creates state-specific Marketplaces, where individuals can go to purchase health insurance. Generally, those with Medicare should not buy health insurance in the Marketplace.
《平價醫療法案》(ACA) 包括對符合資格的美國人，擴大醫療保障範圍、控制醫療保險保費和改善醫療保健提供系統的條款 。 ACA 彌補了聯邦醫療保險D部分的漏洞/保障範圍的差距，並擴大了為有聯邦醫療保險的人提供的預防服務的保障範圍。該法案還創建了州特定市場，個人可以在那裡購買健康保險。一般來說，擁有聯邦醫療保險的人不應在州特定市場購買健康保險。
Annual Notice of Change (ANOC)
The Annual Notice of Change (ANOC) is the notice you receive from your Medicare Advantage or Part D plan in late September. This notice gives a summary of any changes in the plan’s cost and coverage that will take effect on January 1 of the next year. Review this notice to see if your plan will continue to meet your health care needs in the following year. If you do not receive an ANOC from your plan, you should contact your plan. The ANOC is typically mailed with the plan’s Evidence of Coverage (EOC), which is a more comprehensive list of the plan’s cost and benefits for the upcoming year.
年度變更通知 (ANOC) 是您在9月下旬，從聯邦優惠醫療保險或D部分計劃收到的通知。本通知概述了將於明年1月1日生效的計劃費用和保障範圍的任何變化。查看此通知，需要看您的計劃是否會在下一年繼續滿足您的醫療保健需求。如果您沒有從您的計劃中收到ANOC，您應該聯繫您的計劃機構。 ANOC 通常與保險計劃的保障證明 (EOC) 一起郵寄，而且這是一份更全面的計劃，包含下一年的保費和福利列表。
The benefit period is the amount of time during which Medicare pays for hospital and skilled nursing facility (SNF) services. A benefit period begins the first day you enter the hospital or SNF and ends when you no longer receive hospital care or skilled care in an SNF for 60 days in a row. With each new benefit period, you pay a new deductible. Your coinsurance is determined by the number of days you have been in the facility during each benefit period.
福利期是聯邦醫療保險支付醫院和專業護理機構 (SNF) 所提供的服務時間。福利期從您進入醫院或SNF的第一天開始，到您連續60天不再在需要SNF提供醫院護理或專業護理時結束。對於每個新的福利期，您都要支付新的自付額。您的共同保險取決於您在每個福利期內在護理機構中的天數。
Insurance is designed to protect you from having to pay very high out-of-pocket costs. Catastrophic coverage usually begins after you have spent a pre-determined amount on your health care. Original Medicare Part A and Part B do not offer catastrophic coverage. They always pay the same amount regardless of how much you have spent. The Medicare prescription drug benefit (Part D) does offer catastrophic coverage. After you have spent a certain amount out-of-pocket, you will only pay five percent of the cost of each prescription drug (in addition to your monthly plan premium). Medicare private plans, like regional PPOs (Preferred Provider Organizations), may also have catastrophic coverage or caps on out-of-pocket costs, but these caps may exclude certain high-cost services. Also, Medicare Medical Savings Accounts (MSAs) must pay all or most of your Medicare Part A and B costs after you have met your deductible.
保險的作用就是在保護您免於支付非常高的自付費用。災難性保險通常在您在醫療保健上花費了預定金額後開始。原始聯邦醫療保險A部分和B部分不提供災難性保險，無論您花了多少錢，都是支付相同的金額。 聯邦醫療保險處方藥福利（D 部分）確實提供災難性保險。在您支付了一定的自付金額後，您只需支付每種處方藥費用的 5%（除了您的每月計劃保費）。聯邦醫療保險私人計劃，如區域PPO（優選醫生計劃），也可能有災難性的保障或自付額費用上限，但這些上限可能不包括某些高費用服務。此外，在您達到自付額後，聯邦醫療保險醫療儲蓄賬戶 (MSA) 必須支付您的聯邦醫療保險A部分和B部分的全部或大部分費用。
A discharge plan is a plan for post-hospitalization care intended to identify an individual’s need for medical and social services and resources available to help prevent re-hospitalization. A discharge plan must involve:
- input from you and your representatives about your preferences and care needs after hospitalization;
- information and instructions to you and your caregivers about post-hospitalization care you need; and
- arrangement of necessary post-hospital services, transfers, and referrals to appropriate services and facilities.
A Medigap is a supplemental insurance policy that is sold by private insurance companies to fill “gaps” in Medicare. This insurance policy is usually available in the form of twelve different plans labeled A through L and works only with Original Medicare.
Source 文章來源: https://www.medicare.gov/glossary/