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Maximum Out-of-Pocket Amount (MOOP)

The most that you pay out-of-pocket during the calendar year for in-network covered Part A and Part B services. Amounts you pay for your Medicare Part A and Part B premiums, and prescription drugs do not count toward the maximum out-of-pocket amount.

Medicaid

A joint Federal and State program that helps with medical costs for people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Medi-Cal

California's name for Medicaid, the State and Federal program of medical aid for needy and low-income persons.

Medicare

The Federal health insurance program for people 65 years of age or older, people under age 65 with disabilities, or people with End Stage Renal Disease (generally those with permanent kidney failure or who need dialysis or a kidney transplant).

Medicare Advantage Organization

A public or private organization that is under contract with the Centers for Medicare and Medicaid Services to provide covered services. Medicare Advantage Organizations can offer one or more Medicare Advantage Plans. SCAN is a Medicare Advantage Organization.

Medicare Advantage Plan

Sometimes called Medicare Part C, these are plans offered by Medicare Advantage Organizations to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Organizations may offer more than one plan in the same service area.

Medicare Advantage Prescription Drug (MAPD) Plans

A Medicare Advantage plan that includes coverage for Medicare Part D (prescription drug coverage).

Medicare Beneficiary

A person determined to be eligible for Medicare by Social Security.

Medicare Part A (Hospital Insurance)

Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

Medicare Part B (Supplemental Medical Insurance)

Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that aren't covered by Part A.

Medicare Part C

A plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Also known as Medicare Advantage Plans.

Medicare Part D (Prescription Drug Coverage)

The voluntary Medicare Prescription Drug Benefit Program.

Medi-Medi

A term used to refer to a beneficiary who meets both the Medicare (Federal) definition/criteria as well as the established criteria of the Medicaid (State) program and has enrolled both programs with SCAN.

Member Services Department

A department of SCAN dedicated to answering Member questions concerning non-medical needs such as membership, benefits, grievances and appeals.