Helpful Definitions:
Medicare: a federally funded insurance program that individuals qualify for based on age or disability. There are 3 basic forms: Medicare A, Medicare B, and Medicare D (Medicare.gov, 2024).
Medicaid: a federally funded (and state-funded) insurance program that states manage how they choose to, specifically for low-income adults, families, and those with disabilities, to have access to care (Medicaid.gov, 2024).
Medicare Supplemental Policy: Private insurance companies have policies to assist customers with paying for co-pays that may arise when using Medicare benefits.
Managed Care: a form of health insurance that contracts health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. How much care the plan will pay depends on the network’s rules. There are 3 varieties:
- Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care.
- Preferred Provider Organizations (PPO) usually pay more if you get care within the network. They still pay for a part of the cost if you go outside the network.
- Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care (Medlineplus.gov, 2019)
Medicare Replacement Policies: a private insurance that pays like Medicare.
Nursing homes or skilled nursing facilities are organizations licensed by the state and federal government to provide skilled care to adults aged 18 or older. They usually accept private pay, Medicare, Medicaid, and other insurance. A unit is usually a simple space that allows for complex care and services. This can be offered in a private or shared (double) room.
Assisted living: a lower level of care than a nursing home but usually has 24/7 that can do much for you or your loved one.
Independent living: single units of apartments, condos, etc. that seniors 55 and older live in. Services may be offered or not.
Home health care: services provided in the home to someone by a caregiver or a licensed nurse depending on the service.
Hospice: end-of-life care provided in the home or other setting.
Continuing care retirement community: an organization that offers a variety of care and services under one roof.
Life plan community: a newer term for continuing care retirement community
C.N.A: certified nursing assistant
LPN: licensed practical nurse.
RN: registered nurse
T.M.A: trained medication aide
Caregiver: an individual that provides care in the home or assisted living.
DON: Director of Nursing, an individual who oversees all clinical operations in a nursing home.
References:
Medicaid.gov. (2024). Medicaid. Retrieved from: https://www.medicaid.gov/medicaid/index.html
Medicare.gov. (2024). Parts of Medicare. Retrieved from: https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
Medlineplus.gov. (2019). Managed Care. Retrieved from: https://medlineplus.gov/managedcare.html
