Wellcare Hot Words Flashcards
(19 cards)
Member
Eligible and enrolled in Wellcare
Eligible to participate in a medicare and/or medicaid program
Beneficiary
Medicare- is the Federal health insurance program for?
-65 yrs old and above
-certain ones under 65 who have dissabilities
-individuals who have ESRD (end-stage renal disease)
-individuals that have medicare-covered government employment
-individuals with amyotrophic lateral sclerosis (lou gehrig’s disease
Medicaid is what?
A joint federal and state program that helps with medical costs for those low income individuals and limited resources
PDP is the term for?
Prescription drug plan
Beneficiaries covered by both medicare and medicaid
Dual eligible
This is the list of prescriptions under part D
Formulary
Deductible
The amount a member must pay before the wellcare begins to pay
Premium
Monthly payment for healthcare coverage
Co-insurance
Kind of cost where costs are split into percentage
Generic drugs
A drug that has a same ingredients with brand drugs but is more low cost
Prescription drugs that are sold under a trademark brand name
Brand name drugs
The maximum dollar amount a beneficiary can reach before they have the coverage gap
Coverage limit
A lag or hole in the coverage also known as “donut hole”
Coverage gap
TrOOP
True out of pocket costs
Financial assistance granted by the government
Subsidy
The intentional deception or misrepresentation that an individual knows or should know to be false or does not believe to be true and makes knowing the deception could result in some unauthorized benefit to himself or some other person’s
Fraud
Any practice inconsistent with sound financial, business or generally accepted medical practice
Abuse
Coverage that they may have with the plan in (part A,B,C or D)
Benefits
