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Federal Consumer Information Center Medicare Questions and Federal Consumer Information Center: Medicare - Questions and Answers

Section 4: Definitions of Important Terms

Coinsurance - The percent of the approved charge that you have to pay either after you have paid the Part A deductible, or after you pay the first $100 deductible each year for Part B.

Deductible - The amount you must pay before Medicare begins to pay either each benefit period for Part A, or each year for Part B.

Fiscal Intermediary - A private insurance company that has contracted with Medicare to process bills (claims) for Part A services.

Medicare Carrier - A private insurance company that has contracted with Medicare to process beneficiary bills (claims) for Part B services.

Peer Review Organizations (PROs) - Groups of practicing doctors and other health care professionals paid by the federal government to monitor the care given to Medicare patients. They are responsible for reviewing beneficiary complaints about the quality of care provided by inpatient hospitals, hospital outpatient departments and hospital emergency rooms; skilled nursing facilities; home health agencies; Medicare managed care plans and ambulatory surgical centers.

Premium - Monthly payment for health care coverage to Medicare, an insurance company, or a health care plan.

State Health Insurance Assistance Program (SHIP) - A State organization that receives money from the Federal government to give free health insurance counseling to Medicare beneficiaries. Most of these counselors are volunteers. They are trained to answer questions about: health insurance, Medicare bills, Medigap insurance to supplement Medicare, paying for long- term care, payment denials and appeals, Medicare rights and protections, and choosing a Medicare managed care plan.

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