Mandated benefits
Benefits that health insurance plans are required by state or federal law to provide to policyholders and eligible dependents.
Mandatory supplemental benefits
Additional benefits included in Medicare coordinated care plans that are required to be purchased by you. These benefits will differ among Medicare Advantage plans.
Managed care
Generally a health care delivery system that links doctors, hospitals and an insurance plan to deliver care to the plan's members with the intent of improving quality and reducing costs. Health insurance can manage care in a number of ways, including requiring members to choose a primary care provider, to obtain the primary care provider's permission to see a specialist and to use only providers with the plan's network of providers.
Managed care plan
Any health plan that requires or creates incentives for an enrollee to use providers that are owned, managed, or under contract with the insurer offering the health benefit plan.
Market value
A real estate term that describes what the current value of your home would be if you were to sell it--including the price of the land. This amount generally is not involved in determining what amount to purchase under a homeowner's policy. Since the object of most property insurance policies is to pay the insured the actual cash value or the cost to repair or replace the damaged or destroyed property, the "market" or "book" values are not used in loss settlements.
Medical payments coverage
Provision of liability policies and the liability sections of package insurance policies, such as the personal automobile policy, that pays medical expenses without regard to fault. The insured does not admit liability for bodily injury to another party, nor does an injured party forfeit the right to sue the insured.
Medically necessary
Services or supplies that meet the following: (1) they are appropriate and necessary for symptoms, diagnosis, or treatment of the medical condition; (2) they are provided for the diagnosis or direct care and treatment of medical conditions; (3) they meet the standards of good medical practice within the medical community in the service area: (4) they are primarily for the convenience of the patient or provider; (5) they are the most appropriate level or supply of service that can safely be provided.
A federal health insurance program for people age 65 and older and some younger disabled people. In original Medicare, a fee-for-service program, you can go to any doctor or hospital that participates in Medicare. Medicare will pay the doctor or hospital directly for eligible services they provide. Medicare has two parts: Part A, which covers hospital services and Part B, which covers doctor services.
Medicare Advantage
A federal program providing Medicare coverage through the private insurance market. These plans have a special arrangement between the federal Centers for Medicare & Medicaid (CMS) and certain HMOs. The federal government pays the HMO a set amount for each Medicare enrollee. The HMO agrees to provide all Medicare benefits. The HMO will also provide some additional benefits that may be at an additional cost.
Medicare Advantage eligible individual
Anyone eligible for Medicare Part A and enrolled in Medicare Part B who is not receiving end stage renal disease (ESRD) benefits.
Medicare Advantage organization
A private or public entity that agrees to meet the contractual requirements to offer a Medicare Advantage health plan. A Medicare Advantage organization may offer more than one plan or type of plan.
Medicare Select
A Medicare supplemental health insurance product that will pay the Medicare deductibles and copayments and some additional benefits only if the covered services are obtained through specified health care professionals.
Medicare Supplement
Insurance policies sold by private insurance companies to fill "gaps" in original Medicare plan coverage. Medigap policies only work with original Medicare.
A term used to refer to Medicare supplement and Medicare select policies designed to fill the "gaps" in original Medicare plan benefits.
A significant misstatement in an application form. An insured is required to answer truthfully all questions on an insurance application. The insurance company can void the policy if it would not have issued a policy had it known the facts.
Misstatement of age
Life insurance wording that specifies the action the insurer will take if, at the insured's death, the insurer discovers that the insured's age was misstated in the application and the misstatement has resulted in an incorrect premium for the amount of insurance purchased.

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