Major services are dental procedures concerned with the restoration of teeth by cast restorations such as inlays, onlays, crowns or veneers. Major services may include endodontics (root canals) or periodontics (tissue/bone treatment).
This is a healthcare system under which providers are organized into a network in order to manage the cost, quality, and access to healthcare. Managed care organizations include Preferred Provider Organizations (PPOs) and Dental Health Maintenance Organizations (DHMOs).
Managed Care Support Contractor (MCSC)
An MCSC is a civilian health care contractor of the Military Health System that administers TRICARE in one of the TRICARE regions. An MCSC (Humana Military is an MCSC) helps combine the service available at MTFs with those offered by the TRICARE network of civilian hospitals and providers to meet the health care needs of the TRICARE beneficiaries.
Managed care organizations serve Medicare or Medicaid beneficiaries with a network of employed or affiliated providers. These organizations usually include Health Maintenance Organizations, Preferred Provider Organizations, and Private Fee-for-Service plans.
A Medicare Advantage plan (HMO, PPO, or PFFS) combined with a Prescription Drug Plan (PDP) for one total monthly premium, MAPD is administered by a Medicare Advantage Organization (MAO).
This is another term for maximum.
The maximum dollar amount a benefits program will pay towards the cost of a service is the maximum allowance. This is specified in the program's contract provisions, (e.g. Usual, Customary, and Reasonable [UCR] Table of Allowances).
Maximum annual benefit (MAB)
This is the maximum dollar amount a health plan will pay during a plan period. The plan period is usually your effective date through the end of the calendar year.
This is the maximum dollar amount a benefit program will pay toward the cost of care for an individual or family within a specific period.
Maximum fee schedule
This refers to an arrangement in which a participating provider agrees to accept a set amount as the total fee for one or more covered services.
Maximum medical out-of-pocket
This is the most money you will be required to pay within a year for deductibles and coinsurance. Regular premiums are not included in calculations of your maximum medical out-of-pocket expenses.
Maximum plan benefit coverage
The maximum dollar amount a health plan will pay during a benefit period is called the maximum plan benefit coverage. Medicare plans usually only set this type of limit on services for which the plan offers enhanced benefits.
Mbr Resp Amt
This abbreviation means member responsible amount.
A joint federal and state program, Medicaid helps cover medical expenses for low-income individuals. Medicaid programs vary from state to state, but most healthcare costs are covered if you qualify for both Medicare and Medicaid.
Medical insurance (Medicare Part B)
Medical expenses such as doctors' services, outpatient hospital services, and a number of other non-hospital medical services and supplies are covered under Medicare Part B.
Healthcare services or supplies that are deemed appropriate for a particular sickness or injury are referred to as medically necessary. Just because a provider prescribes, authorizes, or performs a service does not mean it will be considered medically necessary under your insurance plan or that the costs will be covered. To be considered medically necessary, a service or supply must meet the standards of good medical practice and be the most appropriate care that can be safely provided to you. Medically necessary services do not include those offered solely for your convenience or the convenience of a doctor or hospital.
Medicare is the federal health insurance program available to people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).
Medicare + Choice
Now called Medicare Advantage.
Medicare Advantage Health Maintenance Organization (HMO) plan
See the definition for Health Maintenance Organization (HMO).
Medicare Advantage Organization
This is a state-licensed public or private entity that meets Centers for Medicare & Medicaid Services (CMS) requirements to hold a Medicare Advantage contract.
Medicare Advantage Organization (MAO)
The state licensed business entity, certified by CMS as meeting the Medicare Advantage requirements, MAO offers a plan or plans and is legally responsible for any liability associated with the delivery or non-delivery of services offered through the plans.
Medicare Advantage Plan (MA)
A Medicare plan offered by a private insurer, an MA includes all of the benefits of Original Medicare (also called traditional Medicare) and may also include Medicare Part D prescription drug coverage, as well as extra benefits. When you have a Medicare Advantage plan, you still have Medicare and must continue paying Medicare premiums.
Medicare Advantage Preferred Provider Organization (PPO) plan
See the definition for Preferred Provider Organization (PPO).
Medicare Advantage Private-Fee-for-Service (PFFS) plan
See the definition for Private Fee-for-Service (PFFS).
Medicare and You Handbook
This booklet includes information on things such as how to file a claim and what type of care is covered under the Medicare program. All Medicare beneficiaries receive this handbook when they first enroll in the program.
Health insurance available under Medicare Part A and Part B is also known as your Medicare benefits.
Medicare coverage consists of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). See the definitions for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance)
Medicare Part A (hospital insurance)
This federal insurance covers hospital expenses such as room and board and other inpatient hospital services.
Medicare Part B (medical insurance)
Medical expenses such as doctors' services, outpatient hospital services, and a number of other non-hospital medical services and supplies are covered under this federal insurance program.
Medicare Part C (Medicare Advantage plans)
This coverage is offered by a Medicare Advantage Organization. You receive a specific set of health benefits at a uniform premium and uniform level of cost-sharing. Part C is available to all Medicare beneficiaries who live within a plan's service area.
Medicare Part D (prescription drug coverage)
This optional Medicare prescription drug coverage is offered through private companies and organizations. You can get Part D coverage through a Medicare-approved stand-alone drug plan or a Medicare Advantage HMO, PPO, or PFFS plans that includes drug coverage.
Medicare Parts A and B
This pay-per-visit health plan lets you go to any doctor, hospital, or other healthcare provider who accepts Medicare. Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance plus the deductible). See the definitions for coinsurance and deductible.
This is the monthly premium you pay for your Medicare Part A coverage, Medicare Part B coverage, or Medicare Part D coverage.
Medicare savings programs
Through these programs, millions of people with Medicare are able to save money each year. States have programs for people with limited incomes and resources that pay Medicare premiums. Some programs may also pay your Medicare deductibles and coinsurance.
Medicare select insurance plan
A type of Medicare Supplement policy, this plan may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits. Contact your state insurance department for more information.
Medicare Supplement open enrollment period
This is a one-time-only, six-month period when federal law allows you to buy any Medicare Supplement policy that is sold in your state. It starts in the first month that you are age 65 or older and covered under Medicare Part B. During this period, you can't be denied a Medicare Supplement policy or charged more due to past or present health problems. Some states may have additional open enrollment rights under state law.
This is the amount Medicare and you pay to a doctor or supplier for a service or supply. It may be less than the actual amount charged by a doctor or supplier.
Medicare-required drugs and supplies
These are specific prescription drugs and products Medicare requires private insurers to cover.
A member is an individual enrolled in a benefit program.
This is your unique identifying number under the dental plan.
The name of the person for which a claim is submitted.
Military Treatment Facility (MTF)
An MTF is a medical facility (hospital, clinic, etc.) owned and operated by one of the component services of the Department of Defense (e.g., U.S. Army, U.S. Navy, and U.S. Air Force) and usually located on or near a military installation.
This is the monthly payment you make to an insurance company or a healthcare plan for healthcare coverage in addition to your Medicare Part A or Part B premium.
A Medical Review Officer is a physician qualified to interpret the results of drug testing.
My Drug List
You can create this online by selecting and adding to your list any drugs you take now or expect to take. You can then also use the Rx Calculator to estimate your prescription drug costs.