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INSURANCE 101

Across
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap.
A health plan that contracts with doctors, hospitals, pharmacies, and other health care providers to provide members of the plan with services and supplies at a discounted price
Health care services that your health insurance or plan doesn’t pay for or cover
A cap on the benefits your insurance company will pay in a year while you're enrolled in a health insurance plan.
Someone who you choose to act on your behalf, like a family member or other trusted person.
Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.
A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.
A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
A limit in a range of major life activities. This includes activities like seeing, hearing, walking and tasks like thinking and working.
Down
The yearly period when people can enroll in a health insurance plan
The health care items or services covered under a health insurance plan.
A federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates
The organization of your treatment across several health care providers
The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
A program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage. There are two ways to get Medicare prescription drug coverage: through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that includes drug coverage. These plans are offered by insurance companies and other private companies approved by Medicare.
A year of benefits coverage under an individual health insurance plan.
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible
A request for your health insurance company or the Health Insurance Marketplace to review a decision that denies a benefit or payment.
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.