Maximum amount on which payment is based for covered health care services. If your provider charges more than the allowed amount, you may have to pay the difference.

A provision to help avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental, or other care/treatment. One plan becomes the “primary” plan and the other becomes the “secondary” plan. This establishes an order in which the plans pay their benefits.

Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. You pay coinsurance plus any deductibles you owe.

A fixed amount you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of service.

A set dollar amount that you must pay out-of-pocket toward certain health care services before insurance starts to pay. Deductibles run on a calendar-year basis.

Equipment and supplies ordered by the health care provider for everyday or extended use. Coverage for DME may include oxygen equipment, wheelchairs, crutches, or blood testing strips for diabetics.

Refers to the use of health care professionals who participate in the health plan’s provider and hospital network.

A physician or other health care provider who does not have a contractual relationship directly or indirectly with a group health plan or group or individual health insurance coverage offered by a health insurance issuer.

Refers to the use of health care professionals who are not contracted with the health insurance plan.

The highest amount you are required to pay for covered services. Once you reach the out-of-pocket maximum(s), the plan pays 100% of expenses for covered services. Out-of-pocket maximums run on a calendar-year basis.

The amount that must be paid for your health plan. You or your employer usually pay it monthly, quarterly, or yearly.

A decision by your health insurer (i.e. Blue Cross Blue Shield) that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. It is sometimes called preauthorization, prior approval, or precertification. Your health plan may require prior authorization for certain services before you receive them, except in an emergency. Prior authorization isn’t a promise your health insurance or plan will cover the cost.

Specific directions or instructions from your primary care physician that direct a member to a participating health care professional for medically necessary care. A referral may be written or electronic.

When providers bill a patient for the difference between the amount they charge and the amount the patient's insurance pays. Members in the MSU Medicare Advantage Plan who receive services with a provider that accepts Medicare should not be billed a balance beyond the Medicare approved amount for any covered service or benefit.

CMS is the federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Programs across the country. It is a division of the Department of Health and Human Services.

Medicare Advantage plans (also known as Medicare Part C) are a type of Medicare health plan offered by a private insurance company. These plans provide all your Medicare Part A and Part B benefits and additional benefits. Some also cover Medicare Part D benefits. If they include Medicare Part D benefits, this is called an MAPD plan.

In 2018, CMS started a project to replace the social security number on the Medicare Health Insurance card. It also replaced the Health Insurance Claim Number (HICN) that providers used to process claims. Your Medicare card has the 11-digit identifier under the title "Medicare Number."

Hospital insurance offered through CMS that covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medical insurance offered through CMS that covers certain doctors' services, outpatient care, medical supplies, and preventative services.

A Medicare Advantage plan offered through a private insurance company that contracts with Medicare to provide coverage for Medicare Part A, Part B, and sometimes Part D.

Prescription drug coverage offered through CMS that covers certain prescription drugs, including many recommended shots or vaccines.

You will have the same level of benefits at any provider nationwide who accepts Medicare and is willing to submit the claim to Humana regardless of whether the provider is considered in-network or out-of-network.