NEA Retiree Health Program: Glossary of Terms

Excess Charge is the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge.

Hospital or Skilled Nursing Facility – A hospital is an institution that provides care for which Medicare pays hospital benefits. A skilled nursing facility is a facility that provides skilled nursing care and is approved for payment by Medicare, or is qualified to receive such approval if so requested. Custodial care does not qualify as an eligible expense.

Lifetime Reserve Days are limited by Medicare to 60 days during your lifetime. Once these are used, Medicare provides no hospital coverage after 90 days of a benefit period. (See plan descriptions.)

Medicare Eligible Expenses are the health care expenses which Medicare recognizes as reasonable and medically necessary. Physicians under Medicare can agree to accept Medicare’s Eligible Expense as their fee amount. Your physician or surgeon may charge you more.