Simple definitions

Annual enrollment period

The specific period each year – currently October 15 to December 7 – when any eligible person can sign up for a Medicare Advantage plan or change their plan for any reason.

Annual notice of changes (ANOC)

A document that each member of a Medicare plan receives each year. It describes changes to your plan’s costs and benefits. You receive it before the start of the annual enrollment period each autumn.

Beacon Health Options

A BCBSRI partner that offer independently licensed mental health and substance abuse professionals who work with you and coordinate care with your team of providers to get you access to the resources and services you need. Learn more

Benefit

A service covered by your health insurance plan such as a doctor visit or X-ray.

BlueCHiP for Medicare

A Medicare Advantage plan offered by BCBSRI. With this plan, your healthcare services are paid by BlueCHiP for Medicare instead of Medicare. Your healthcare providers will file claims and be paid by BlueCHiP for Medicare. They may offer more benefits than Original Medicare. See our plans

Blue MedicareRx

A standalone prescription drug plan (PDP) for Medicare members that adds prescription drug coverage to Original Medicare. Learn more

Case management (also known as care coordination)

A process of coordinating care between your insurer and your healthcare providers to help manage your health. Case managers are often nurses, dieticians, and social workers. Learn more

Centers for Medicare & Medicaid Services (CMS)

The federal agency that oversees Medicare and Medicare Advantage plans.

Chronic condition

A long-term illness that affects your quality of life, such as diabetes, asthma, heart disease, and arthritis. Learn more

Claim

The bill that a doctor sends to your health insurance company after they treat you.

CMS number

This number, which appears on your BCBSRI member ID card, is used by the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicare. It refers to your specific plan, such as BlueCHiP for Medicare Plus or BlueCHiP for Medicare Advance

Coinsurance

A portion of the cost you pay when you get healthcare.

Example: A doctor might charge $100 for a visit. If your health insurance has a 10% coinsurance, you would pay the doctor $10 and your insurance would pay the doctor $90.

Copay

A specific dollar amount you pay when you get healthcare.

Example: A doctor might charge $100 for a visit. If your health insurance has a $20 copay, you would pay the doctor $20 and your insurance would pay the doctor $80

Consumer-directed health plans (CDHPs)

These plans generally have higher deductibles in exchange for lower premiums and the ability to open a health savings account, which could save you money on taxes. They sometimes are called high-deductible health plans.

Deductible

If you need medical care, a deductible is the amount you pay for your care before the health insurance company starts to pay its share.

Doughnut hole

A stage of Medicare Part D prescription drug coverage known as the coverage gap, when medications are not covered. Learn more

Durable medical equipment

Equipment and supplies ordered by a healthcare provider for everyday or extended use, such as oxygen equipment, wheelchairs, crutches, or blood testing strips for people with diabetes.

Evidence of coverage (EOC)

A document that each member of a Medicare plan receives each year. It gives you details about what the plan covers, how much you pay, and more. You receive it before the start of the annual enrollment period each autumn.

Extra Help

A Medicare program to help people with limited income and resources pay Medicare prescription drug costs like premiums, deductible, and coinsurance.

Formulary

The list of prescription drugs that are covered by your health insurance. These are often divided into levels, or tiers. Drugs listed in the lower tiers cost you less.

Health maintenance organization (HMO)

An organization that provides healthcare coverage to its members through a network of doctors, hospitals, and other healthcare providers. HMO plans usually require that all of a member’s care, including their annual exam, any diagnostic tests, and referrals to specialists be coordinated through the member’s primary care physician (PCP).

Hospital readmissions

A situation where you were discharged from the hospital and wind up going back in for the same or related care within 30, 60 or 90 days. The number of hospital readmissions is often used in part to measure the quality of hospital care, since it could mean that your follow-up care wasn't properly organized or that you weren't fully treated the first time.

Initial enrollment period

The seven-month period before and after you turn 65 when you can sign up for Medicare. Learn more

Living Fit

The BCBSRI program that offers discounted gym memberships at more than 50 local fitness centers for as low as $5/month.

Mail order drugs

Prescription medications that you can order by phone or online and have them delivered to your door. BCBSRI members have a $0 copay for a 90-day supply of many common medications. Learn more

Medicaid

A state-administered health insurance program for low-income families and children, pregnant women, the elderly, people with disabilities, and in some states, other adults.

Medicare Advantage plan

Also known as Medicare Part C, a Medicare Advantage plan allows you to get Medicare coverage through a private insurer. This coverage takes the places of Medicare Parts A and B (hospital and medical services) and may cover Medicare Part D prescription drugs as well. Generally, you must use providers in the plan network, except in emergency or urgent care situations. See our plans

Medicare number

Your Medicare number that appears on your red, white, and blue Medicare card. Until April 2018 this was the same as your Social Security Number. It now has changed to be a separate number in order to help protect your privacy.

Medicare Concierge Team

The BCBSRI customer service team dedicated to helping Medicare members anytime you need help with your plan or benefits. Learn more

Medicare Part A

Covers inpatient care in hospitals, skilled nursing facilities, hospice care, and home healthcare. Learn more

Medicare Part B

Covers doctors’ services and other outpatient care. Learn more

Medicare Part C

Also known as Medicare Advantage, allows you to obtain Medicare coverage through a private insurer. For example, BCBSRI offers BlueCHiP for Medicare plans. Learn more

Medicare Part D

Optional coverage offered by private insurers for prescription drugs not covered under Medicare Parts A or B. The purchase of Part D is optional, but you may face a late enrollment penalty if you do not sign up when you are first eligible for Medicare. It also may be included in Medicare Advantage plans. Learn more

Medicare Savings Program

State Medicare Savings Programs (MSP) programs help pay premiums, deductibles, coinsurance, copayments, prescription drug coverage costs.

Medigap

A common name for Medicare Supplement plans, like Plan 65 from BCBSRI. See our plans

MyAdvocate

A free service that can help you find and apply for programs that might save you money, such as Medicare savings programs and Extra Help with Medicare Part D prescription drug costs.

Network

A group of hospitals, pharmacies, doctors, and others who work with your health insurance company to keep healthy. They have agreed to care for you at a lower price than if you didn’t have your health insurance plan. Learn more

Original Medicare (Parts A and B)

Includes Medicare Parts A and B, the federal programs that most people mean when they say “Medicare.” Learn more

Out-of-network

Services provided by doctors, hospitals, and other healthcare providers who have not contracted with the insurance company. These services may have different copayments or coinsurance than in-network services, or they may not be covered at all (meaning that the member is responsible for the full cost of the services).

Out-of-pocket maximum

This is the most you would pay in one year before your health insurance starts to pay for all of your covered health benefits.

Over-the-counter (OTC)

Medicine or another healthcare item, such as bandages, that you can buy without a prescription.

Patient-centered medical home (PCMH)

A type of doctor’s office with a team of people committed to improving your health and helping you live a healthier lifestyle. Your PCMH team can help you achieve your health goals. For example, they might help you quit smoking, control your diabetes or asthma, lose weight, or manage your stress.

Plan 65

This plan, offered by BCBSRI, is a supplement to Original Medicare. These types of plans often are called Medigap. Original Medicare pays its share first, then Plan 65 pays some or all of the remaining costs depending on the plan you choose. Plan 65 covers the coinsurance and deductible amounts that Original Medicare does not pay. See our plans

Point of service (POS)

POS plans combine elements of both HMO and PPO plans. As a member of a POS plan, you may be required to choose a primary care physician who will then make referrals to specialists in the health insurance company's network of preferred providers. Care rendered by non-network providers will typically cost you more out of pocket, or may not be covered at all (you may be responsible for the full cost).

Preferred pharmacy

Pharmacy retailers, like CVS (including Target locations), Walmart, Stop & Shop, and some independent pharmacies, that offer lower prices on certain drugs. Learn more

Preferred provider organization (PPO)

A type of health plan with a preferred network of doctors and other healthcare providers. Members usually do not have to get referrals for specialty or out-of-network care, but they may have higher out-of-pocket costs for out-of-network care.

Premium

The amount of money you pay to your health insurance company each month in exchange for your health insurance plan.

Prescription

An order from your doctor for you to receive and take a specific medication. You then get your medication by having your prescription filled at a pharmacy.

Prescription drug plan (PDP)

A standalone plan that adds prescription drug coverage to Original Medicare. Learn more

Preventive care

Steps you and your doctor take to help you stay healthy, even when you feel well. They might include your annual checkup or some tests for cancer.

Primary care provider (PCP)

The main doctor, nurse practitioner, or physician’s assistant you go to for regular healthcare. Your PCP is your partner in health. They know your health history and help you get the best care. Learn more

Provider directory

A comprehensive list of all of the providers in the BlueCHiP for Medicare network.

Referral

A written or verbal request from your primary care provider (PCP) to another doctor or lab for a specific service for you. Learn more

Rehabilitation services (rehab)

Healthcare services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled. These services may include physical, occupational, and speech therapy services in a variety of inpatient and/or outpatient settings.

Screening

A test, such as a mammogram or colonoscopy, that can help find a health problem early, before it gets worse.

Second Act

Volunteer matching program for BCBSRI members in partnership with community agencies and organizations.

Secure messaging service

Called Your Blue Wire RI, it delivers reminders about your health and your plan right to your mobile phone.

Special enrollment period

If you have a significant life event, such as lose your coverage or move into an area no longer covered by our insurance company, you may be eligible to change your Medicare Advantage plan.

Specialist

A doctor who has special training in treating a certain illness or part of the body. Your primary care provider (PCP) may suggest you see a specialist if you have a special health problem. For example, a cardiologist treats the heart and an oncologist treats cancer.

Specialty drugs

Medicine that is prescribed to treat chronic or long-term conditions, such as infertility, HIV, cancer, multiple sclerosis, and others. These expensive drugs may require special monitoring by a doctor to reduce health risks and watch for side effects.

Summary of benefits

A quick summary of the key benefits of your BlueCHiP for Medicare plan.

The Rhode Ahead

BCBSRI member newsletter, in print and online, with plan updates, health tips, recipes, and ideas for active, healthy lifestyles. Learn more

Vaccination

Medicine that helps prevent illnesses like flu.

Virgin Pulse®

A Rhode Island-based company that powers the BCBSRI wellness program with an app or web-based tool for tracking steps, joining challenges with friends, and learning healthy habits

Your Blue Store

Locations where BCBSRI members can talk to customer service team face-to-face, pay bills, take exercise classes like yoga and salsa, and attend seminars on health, nutrition, and other topics. Learn more

Your Blue Touch RI

The mobile app for BCBSRI members that allows you to access your plan information and benefits from your mobile phone.