Medicare terms

Learn more about Medicare. Start with these definitions.

F

federal poverty level

In order to be eligible for Medicaid (as a full dual-eligible beneficiary, or for partial assistance with things like Medicare premiums and out-of-pocket costs) or Extra Help financial assistance, a Medicare beneficiary must have income that doesn’t exceed certain percentages of the federal poverty level (eligibility varies depending on the program, with more assistance available to people with lower incomes; asset tests are also common, meaning that the beneficiary must have limits assets in addition to a fairly low income in order to qualify for assistance through the Medicaid program).

The FPL, which changes annually and is published each year by HHS, is $12,140 for a single person in 2018.

federally qualified health center

A federally qualified health center is a community-based facility that offers comprehensive primary and preventive care to patients, regardless of their ability to pay for services. Facilities may include community centers or homeless shelters in “medically underserved areas” where individuals lack access to services.

fee-for-service

Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered. Original Medicare is an example of fee-for-service coverage, and there are Medicare Advantage plans that also operate on a fee-for-service basis.

Alternatives to fee-for-service programs include value-based or bundled payments, in which providers are paid based on outcomes and efficiency, rather than for each separate procedure that they perform.

fiscal intermediary

A fiscal intermediary is a private company contracted by Medicare to pay bills – such as hospital expenses – for Medicare Part A and Part B.

formulary

A formulary is the list of approved prescription drugs that Medicare will cover.