Medicare terms

Learn more about Medicare. Start with these definitions.

P

palliative care

Palliative care is care that improves the quality of life for patients, making the patient as comfortable as possible by anticipating, preventing, diagnosing and treating their symptoms (as opposed to trying to cure the illness itself). In addition to medical care, palliative care can incorporate psychological, social and spiritual support for patients and for families.

Although palliative care is sometimes conflated with hospice care, palliative care is not limited to patients with terminal illnesses. In other words, while all hospice care is palliative care, the reverse is not true. Palliative care can be beneficial to any patient with a serious medical condition that might impact their quality of life. The National Institute on Aging notes that palliative care “can be helpful at any stage of illness and is best provided from the point of diagnosis.”

In non-hospice situations, regardless of prognosis, palliative care can be provided alongside curative care, in order to alleviate symptoms and side-effects, reduce pain, and improve the patient’s quality of life while curative care is ongoing. As an example, a patient with cancer might receive treatments to alleviate pain and nausea (palliative), while also receiving radiation and chemotherapy to treat the cancer itself (curative care).

Medicare does cover hospice care, which is palliative care. And depending on the medical necessity, Medicare also covers palliative care alongside curative care.

patient protection and affordable care act (PPACA)

The Patient Protection and Affordable Care Act (PPACA) – more commonly referred to as the Affordable Care Act or Obamacare – is the landmark health reform legislation signed into law by President Barack Obama in 2010.

See Affordable Care Act (ACA).

 

pre-existing condition

A pre-existing condition is a medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining coverage.

preferred provider organization

A preferred provider organization (PPO) is a Medicare Advantage plan which gives policy holders an incentive use the providers (doctors, hospitals) within the plan’s network of service providers. In return, the plan pays a higher percentage of your health care expenses.

prescription drug coverage

Prescription drug coverage – or Medicare Part D – subsidizes the costs of brand-name and generic prescription drugs for Medicare beneficiaries. Medicare recipients choose the coverage by enrolling in either a stand-alone prescription drug plan (PDP) – which covers only prescription drugs – or a Medicare Advantage plan, which covers prescriptions and other medical expenses.

Regardless of the plan, you’ll pay a co-pay for each prescription, a monthly premium – which will vary by plan – and an annual deductible. Individuals with limited income and resources may qualify for financial assistance.

prescription drug plan (PDP)

A prescription drug plan (PDP) is one option for individuals who want to enroll in the Medicare Part D prescription drug coverage, which subsidizes the costs of prescription drugs for enrollees. A prescription drug plan (PDP) is a stand-alone plan, covering only prescription drugs. Enrollees who choose the option of prescription drug coverage through a Medicare Advantage plan would also have coverage for other medical expenses as part of that plan.

Enrollees pay a co-pay for each prescription, a monthly premium and an annual deductible.

preventive services

Preventive services are provided to help you avoid becoming sick in the first place. Mammograms, flu shots, Pap tests and pelvic exams are examples of preventive services.

primary care doctor

Your primary care doctor is the physician you turn to first regarding any health care issue that may arise. If you need a specialist, you trust your primary care doctor to give you the best referral for that extra care.

private fee-for-service plan

Private fee-for-service plans are Medicare Advantage plans that allow you to receive care from any hospital or doctor that accepts the plan’s coverage. The plan does not have to follow Medicare guidelines, though, when it comes to paying for the services you receive. (It can cost more or less than Medicare). However, these plans often offer more coverage than Original Medicare.  Private fee-for-service plans sometimes include prescription drug coverage, but if they don’t, you’re allowed to purchase a stand-alone prescription drug plan (that’s not the case with other Medicare Advantage plans).

programs of all-inclusive care for the elderly

Older adults and people over age 55 with disabilities may be eligible for programs of all-inclusive care for the elderly (PACE) – comprehensive care and services from a team of health care professionals using Medicare and Medicaid funds. PACE enrollees must be at least 55, live in the PACE service area, be certified as eligible by the state agency, and be healthy enough to live safely in the community.