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Medicare Advantage (MA)

A type of private health insurance plan that contracts with Medicare to provide all of your Part A and Part B benefits. These plans are offered by private companies approved by Medicare.

Fee-for-service Medicare (Original Medicare)

The traditional government-run Medicare program, consisting of Part A (hospital insurance) and Part B (medical insurance), where Medicare pays a set amount for each service you receive.

Payment Parity

A requirement that different payers (like Medicare Advantage plans and original Medicare) pay the same amount for the same medical services.

Clean Claim

A request for payment submitted by a healthcare provider to an insurance company that contains all the necessary information and has no errors or missing details, allowing for timely processing and payment.

Provider or Supplier

A general term referring to individuals or facilities that provide healthcare services or medical equipment, such as doctors, hospitals, clinics, labs, and pharmacies.

Enrollee

A person who is signed up for and covered by a health insurance plan, such as a Medicare Advantage plan.