National Coverage Determination (NCD)

A decision made by Medicare about whether a particular medical service, procedure, or device is covered nationally. NCDs apply uniformly across the country and are developed based on clinical evidence and input from healthcare experts.

Part A (Medicare)

The hospital insurance part of Medicare, covering inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most individuals qualify for premium-free Part A if they or their spouse paid Medicare taxes while working.

Part B (Medicare)

The medical insurance part of Medicare, which covers outpatient services, doctor visits, preventive care, and certain home health services. Part B requires a monthly premium, which is income-based.

Part D (Medicare)

Prescription drug coverage for Medicare beneficiaries, offered by private insurance plans. Part D helps cover the cost of prescription drugs and has a formulary, or list of covered medications, categorized by cost tiers.

Prescription Drug Coverage

Health insurance coverage that helps pay for the cost of prescription medications. Medicare Part D, Medicaid, CHIP, and many ACA Marketplace plans offer prescription drug coverage.

Retroactive Medicaid

Medicaid coverage that begins prior to the date of application, covering medical expenses incurred up to three months before the application if the individual was eligible during that time. This retroactive coverage helps ensure that people don’t have unpaid medical bills.

Tiered Drug Formulary

A system used by health insurance plans to categorize prescription drugs into different cost tiers, with generic drugs typically in the lowest tier and specialty or brand-name drugs in higher tiers. Medicare Part D and ACA plans often use a tiered formulary system.

Vision Coverage

Insurance coverage for eye care services, such as routine eye exams, glasses, and contact lenses. Medicaid and CHIP often include vision benefits for children, while vision coverage for adults is limited under Medicare unless purchased through a Medicare Advantage plan.

Youth Health Coverage

Healthcare benefits available to children and young adults, primarily through programs like CHIP, Medicaid, and dependent coverage under ACA Marketplace plans. These plans provide comprehensive coverage, including doctor visits, preventive care, vaccinations, and dental services.