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Medicare/Medi-Cal Glossary of Terms

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Term Definition

Incidents or practices that are inconsistent with sound and accepted medical, business, or fiscal procedures.

Activities of Daily Living (ADLs)

Activities that display a person's level of dependence and type of care required. These activities include bathing, continence, dressing, eating, toileting, transferring (getting into and out of a bed or chair) and ambulating (walking).


A health condition that is short-term, following the onset of a disease or as a result of an injury that occurred over a brief time period.

Administrative Law Judge

An official who has responsibility for making a decision in matters of administrative law. Medicare administrative law judges are assigned to the federal Department of Health and Human Services and make decisions regarding Medicare Parts A, B, C, and D appeals that have passed the initial levels of consideration.

Adult Day Care (ADC)

Daytime, community-based programs for adults with functional impairments or disabilities that provide a variety of health, social and related services. Most ADCs also offer meals. ADCs enable individuals to remain at home with supportive, structured day care, providing family members and other caregivers relief from constant care.

Adult Day Health Care

Daytime care, often offered at a licensed community-based day care program. ADHCs are a type of Adult Day Care [see previous definition, above] that provide more intensive health, therapeutic and social services to those at risk of being placed in a nursing home. They also provide family members and other caregivers relief from constant care.

Advance Beneficiary Notice (ABN)

A notice that a doctor or supplier should give a Medicare beneficiary to sign when the doctor or supplier believes that Medicare will not pay for a particular service. By signing the notice, the beneficiary agrees to pay for the service. If the doctor or supplier does not provide the beneficiary with a notice, and Medicare does not pay for the service, then the beneficiary does not have to pay for the service. The advance beneficiary notice applies only to Medicare fee-for-service, not in managed care plans.

Alzheimer's Disease

A progressive neurological disease of the brain that leads to irreversible dementia and the loss of neurons. Alzheimer's disease is characterized by progressive impairment in memory, judgment, decision-making, orientation to physical surroundings and language.

Amyotrophic Lateral Sclerosis (ALS)

Often referred to as Lou Gehrig's Disease, ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. People diagnosed with ALS can receive Medicare the first month their Social Security Disability Insurance (SSDI) benefits begin.

Annual Election Period (Medicare Advanta

The Annual Election Period (AEP) for Medicare beneficiaries runs from November 15 through December 31 each year. During this time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1. This is the only period during which most people with Medicare can change prescription drug plans.


An appeal is a complaint you may file if you disagree with any decision about your health care services. For example, if Medicare doesn't pay for a service you received, you may appeal. An appeal is sent in writing to your Medicare health plan or the Original Medicare plan. There is a formal process you must follow when filing an appeal. More info: Medicare appeals.

Approved Amount

The amount Medicare determines to be reasonable for a service that is covered under Medicare Part B. Medicare Part B will pay for 80% of these approved amounts and no more. If your doctor does not accept the approved amount, by law she or he can charge no more than 15% above this amount. The approved amount is sometimes called the "approved charge" or "allowable amount."

Assignment (for people in Original Medic

If your doctor "accepts assignment," it means that the doctor will charge you the standard rates or "approved amount" that the federal government sets for medical services. Medicare Part B will pay for 80% of these standard charges and no more. If your doctor does not charge the standard rates, by law the doctor cannot charge more than 15% above these rates. You may want to choose doctors who accept assignment to keep your costs low. Doctors and other health care providers that "accept assignment" are referred to as "participating providers."

Assisted Living Facility (ALF)

Residential care settings that provide personal care services, shopping, housekeeping and transportation to the elderly and some younger people with disabilities. An ALF may also help dispense medications. ALF staff is required to be available to provide such assistance 24 hours/day, 7 days/week, and a physician must be available on call at all times.

Attained Age Rating

This is the most common way that Medigap policies are priced in California. Attained age rated policies go up in price as a separate individual cost factor as one ages. In other words, the insurer charges each 75-year-old more than it charges each 70-year-old, instead of spreading that cost between all 70- and 75-year-olds. Typically, these plans appear less expensive at younger ages, but can cost considerably more in later years. In addition, the premium will likely go up each year due to rising health care costs, separately from the cost associated with age.

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