activities of daily living (ADL)

Activities of daily living refers to such activities as bathing, getting dressed, using toilet facilities, eating and moving place to place. Health professionals may gauge the functional status of an individual by their ability to perform ADLs.

​

​

administrative law judge (ALJ)

An administrative law judge is the officer of the court who presides over proceedings when a Medicare enrollee files an appeal, objecting to a Medicare decision or against a Medicare provider.

​

​

adult living care facility

An adult living care facility is a residential care facility that provides support for Medicare enrollees who can’t live by themselves but who don’t need skilled medical services 24 hours a day.

​

​

advance beneficiary notice (ABN)

An advanced beneficiary notice – also called a “waiver of liability” – is a notice that Medicare providers and suppliers are obligated to give to an Original Medicare enrollee when they find that Medicare does not cover the services the enrollee requests.

​

​

advance directive

An advance directive indicates the person designated to make medical decisions for you if you are unable physically or mentally to make those decisions yourself.

​

​

affiliated provider

An affiliated provider is a person or health care facility paid by your health care plan to provide service to you.

​

​

affordable care act (ACA)

The Affordable Care Act (ACA) is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010 and “continued to be rolled out over the next four years.” Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate private insurance industry practices that include rescission and denial of coverage due to pre-existing conditions.

​

​

aging in place

Aging in place refers to a decision individuals make to remain in their homes or their communities as they grow older instead of opting for relocation to long-term care facilities such as assisted living and nursing homes. The decision to remain independent and at home will likely involve consideration of in-home care provided by caregivers who can assist with individuals who might have difficulty with activities of daily living.

​

​

ambulatory care

Ambulatory care refers to health care services that do not include a stay in a hospital.

​

​

amyotrophic lateral sclerosis (ALS) or lou gehrig’s disease

Patients who suffer from amyotrophic lateral sclerosis (ALS) are eligible for Medicare at any age. The disease attacks a person’s motor nerve cells in the spinal cord.

​

​

ancillary services

A hospital or inpatient health care facility provides ancillary services (laboratory testing, X-rays, drugs, etc.).

​

​

annual coordinated election period (ACEP) or annual election period

Annual coordinated election period (ACEP) or annual election period refers to the period of time between October 15 and December 7 during which you can change your Medicare prescription drug coverage or your Medicare Advantage plan (including switching from Original Medicare to a Medicare Advantage plan).  ACEP is also the period of time during which you can enroll in Medicare Part D, if you missed your Initial Enrollment Period.

​

​

annual election period

Medicare’s annual election period – also known as Medicare open enrollment – is the annual period during which Medicare plan enrollees can reevaluate their coverage. During open enrollment, a beneficiary can switch Medicare Advantage plans, switch from Medicare Advantage to Original Medicare, join a Medicare prescription drug plan or drop Medicare Part D coverage entirely.  The enrollment period runs from October 15 to December 7 each year, and changes you make during that time are effective Jan 1.

​

​

appeal

An appeal is a formal request to Medicare to have an official decision reviewed in respect to a payment or policy you may wish to dispute.

​

​

assigned claim

An approved provider submits an assigned claim to Medicare for payment after you have received a service.

​

​

assistive technology

Individuals with disabilities use assistive technology devices to help them function. Medicare does not cover all assistive technologies, but does cover Closed Circuit Television (if a doctor determines it is medically necessary).