See: high-deductible health plan (HDHP) and Medicare Advantage (MA) plan .
Insurance Encyclopedia
Medicare and CHAMPUS (MedCHAMP)
Program for CHAMPUS-eligible individuals younger than the age of 65 who qualify for both Medicare and CHAMPUS. Medicare is the primary payer and CHAMPUS is the secondary payer.
Medicare beneficiary
Anyone entitled to Medicare benefits based on the designation by the Social Security Administration.
Medicare beneficiary (Health Insurance)
Anyone determined by the Social Security Administration to be eligible for Medicare benefits.
Medicare Benefit Policy Manual (BP)
Online instruction handbook that the Centers for Medicare and Medicaid Services (CMS) makes available to Medicare carriers. It includes guidelines for processing and paying Medicare claims, preparing reimbursement forms, billing procedures, and Medicare regulations. This system has online, Internet-only manuals (IOM): National Coverage Determinations Manual, Publication 100, one-time notifications, and manual revision and update notices. This information is helpful to providers when dealing with Medicare contractors for issues such as researching information, claims processing, and appealing denials. Formerly found in Chapter II of the Medicare Carriers Manual, the Medicare Intermediary Manual and various provider manuals and program memorandums.
Medicare benefits
Health insurance available under Medicare Part A and Part B through the traditional fee-for-service payment system.
Medicare Benefits Notice (MBN)
Document that the patient receives after the physician files an insurance claim for Part A services in the Original Medicare Plan. It lists the services the provider billed, the Medicare-approved amount, the Medicare payment, and the amount the patient must pay. The patient may also receive a Medicare Summary Notice (MSN) (formerly known as an Explanation of Medicare Benefits [EOMB] ). See also Medicare Summary Notice (MSN), remittance advice (RA) , and Explanation of Medicare Benefits (EOMB) .
Medicare carrier
See: fiscal agent (FA) and Medicare administrative contractor (MAC) .
Medicare Carriers Manual (MCM)
See: Medicare Benefit Policy Manual (BP) .
Medicare carve-out
Medical benefits offered by employers to retired employees that lowers medical expense benefits so that those benefits are provided by the Medicare program.