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Glossary Terms
Annual Notice of Change
A letter your Medicare plan must send each fall, by the end of September, explaining what is changing next year: costs, coverage, drug list, and sometimes the provider network. Read it before open enrollment.
Coinsurance
Your percentage of the cost of a covered service after you meet your deductible. With 20% coinsurance on a $100 bill, you pay $20 and the plan pays $80.
Copay
A flat fee for a specific service, like $20 for a doctor visit or $10 for a prescription.
Deductible
What you pay out of pocket for covered care before your plan starts paying its share. Some services may be covered before you meet it, so check your plan.
Federally Qualified Health Center (FQHC)
A Federally Qualified Health Center (FQHC) is a federally funded (funded by the US government) nonprofit health organization or clinic that serves medically underserved areas and populations. Services are provided on a sliding scale fee based on individuals’ abilities to pay. More information about FQHCs can be found at www.HRSA.gov.
Formulary
The plan’s list of covered prescription drugs, grouped in tiers that decide what you pay. A drug you take now may not be on next year’s list.
HMO / PPO
HMO: you generally must use the plan’s network and may need referrals; out-of-network care is usually not covered except in emergencies. PPO: more freedom to go outside the network, but you usually pay more when you do.
In-network
Doctors, clinics, and hospitals that have a contract with your plan. Visiting them costs you less, and your plan processes the bill as it should.
Narrow network
A plan that covers only a small, limited group of providers, often tied to one health system. If your doctor is not in that group, your visits may not be covered. CrescentCare is independent and cannot participate in plans limited to one system’s providers.
Out-of-network
Providers that do not have a contract with your plan. You may pay much more, pay the full cost, or not be covered at all (except in an emergency).
Premium
The amount you pay every month to keep your insurance, whether or not you see a doctor.
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