Understand My Care

Glossary

A list of common health care terms and their definitions.

Access

Your ability to get the health care services you want and need.

Accessibility

The design of an environment, such as a doctor’s office, or of a product or service so that all people can use it, including a person with a disability.

Accountable Care Organization (ACO)

Keep your Medicare and Medi-Cal the way they are today, including your same providers. You may get some help arranging your care.

Activities of Daily Living (ADL)

Activities you do during a normal day, like dressing, eating, bathing, and using the bathroom.

Adult Day Center

Centers that provide daytime health care, such as nursing, therapies, social activities, and meals for people who don’t need care 24/7. These programs are safe alternatives to nursing home care and are designed to help people stay healthy and maintain their abilities. You can access a day center through Community-Based Adult Services (CBAS) or the Program of All-Inclusive Care for the Elderly (PACE).

Advocate

Someone who supports you in getting the items and services you need, and who also protects your rights.

Appeal

If a health plan denies or reduces services, you have the right to file a special request to review the health plan’s decision. This special request is called an appeal.

Behavioral Health Care

Services that focus on mental health, as well as substance use conditions. For example, behavioral health care is the type of counseling or medication you would receive to help with feelings of sadness or stress.

Beneficiary

A person who receives benefits from Medicare and/or Medi-Cal.

Benefits

Medicare and Medi-Cal cover health care benefits, which are medically-necessary services that you get from your health plan and/or individual providers. Medicare benefits include doctor visits, hospital care, prescription drug coverage, and some behavioral health services. Medi-Cal benefits include medical equipment and supplies, long-term services and supports, dental coverage, and many behavioral health services.

Cal MediConnect (CMC)

Get your Medicare and Medi-Cal in one health plan with extra benefits like a helper to make sure you get all the care you need. Get extra help to live in your home and community. For people age 21 or older.

Care Coordination

A benefit that ensures that your doctors, specialists, pharmacists, caregivers, Care Coordinators, and other providers (your Care Team) all work together with you to take care of your health.

Care Coordinator

A nurse, social worker, or other health professional that helps you get and manage all the health care services you want and need. Also known as a Care Navigator or Case Manager.

Care Navigator

A nurse, social worker, or other health professional that helps you get and manage all the health care services you want and need. Also known as a Care Coordinator or Case Manager.

Care Team

A group of your doctors and other providers that share information about your health and work together to give you the care you need. Your Care Team may include: your doctors, family members, caregivers, personal care worker, Care Coordinator, and other providers.

Caregiver

A person who provides support for someone who has daily living needs, for example an older adult and/or a person living with a disability. Caregivers can be friends, relatives, or professionals, and can be paid or volunteer.

An IHSS caregiver is a specific type of caregiver that is paid for by the Medi-Cal In-Home Supportive Services (IHSS) program. If you have an IHSS caregiver, you as the consumer choose, hire, supervise, and train your caregiver to meet your needs. You may also fire the caregiver for any reason. IHSS caregivers are paid for by Medi-Cal, but can still be a friend, relative, or professional.

Case Manager

A nurse, social worker, or other health professional that helps you get and manage all the health care services you want and need. Also known as a Care Navigator or Care Coordinator.

Community-Based Adult Services (CBAS)

A Medi-Cal program that provides daytime health care, such as nursing, therapies, social activities, and meals for people who don’t need care 24/7 at an adult day center. These programs are safe alternatives to nursing home care and are designed to help people stay healthy and maintain their abilities.

Copayment (co-pay)

Some health plans require you to pay “cost-sharing” – or a part of the cost of your covered health care services. A co-pay is a type of cost-sharing you may have to pay for a covered health care service. It is usually a fixed amount that you pay when you receive the service. For example, you may also have a co-pay when getting a prescription filled.

Cost-Sharing

Some health plans require you to pay “cost-sharing” – or a part of the cost of your covered health care services.

A co-pay is a type of cost-sharing you may have to pay for a covered health care service. It is usually a fixed amount that you pay when you receive the service. For example, you may also have a co-pay when getting a prescription filled.

A deductible is a type of cost-sharing you may have to pay for a covered health care service before your insurance plan starts to pay. With a $200 deductible, for example, you pay the first $200 of covered services yourself. Sometimes, after you pay your deductible, you must start paying co-pays for each covered health care service you receive.

If you are a dual eligible, you usually can’t be charged a deductible. If a deductible is owed to your provider, it is usually paid for by Medi-Cal. There are organizations that can help if you think you have been wrongly charged a deductible.

Deductible

Some health plans require you to pay “cost-sharing” – or a part of the cost of your covered health care services. A deductible is a type of cost-sharing you may have to pay for a covered health care service before your insurance plan starts to pay. With a $200 deductible, for example, you pay the first $200 of covered services yourself. Sometimes, after you pay your deductible, you must start paying co-pays for each covered health care service you receive.

Dual Eligible Beneficiaries

People who have both Medicare and Medi-Cal. These beneficiaries may be eligible for the care choices described on this website.

Dual Eligible Special Needs Plan (D-SNP)

Get your Medicare and some Medi-Cal through one health plan with extra benefits and extra help arranging your care.

Durable Medical Equipment (DME)

This is equipment ordered or prescribed by your doctor to use at home. DME are reusable and examples are walkers, wheelchairs, and hospital beds. When you’re in a nursing facility, your equipment is provided by your facility.

Enrollee

A person enrolled in a health plan.

Extra Benefits

Health care services provided by your health plan or program that have no extra cost to you. These are services not generally covered by Medicare or Medi-Cal. Also called “additional benefits.”

Fee-for-Service (FFS)

When Medicare or Medi-Cal directly pays for the services you receive. Under fee-for-service, you do not have a health plan. This is sometimes called “original” or “regular” Medicare.

Fully-Integrated Special Needs Plan (FIDE SNP)

Get your Medicare and Medi-Cal in one health plan with extra benefits like a helper to make sure you get all the care you need. Get extra help to live in your home and community. For people who need extra help, age 65 years or older.

Grievance

A complaint or dispute where you express displeasure with any aspect of your care or the operations of your health plan or its providers. Grievances need to be reported orally or in writing and typically need to be filed within 60 days of the grieved action. Examples of a grievance are problems getting an appointment or disrespectful behavior by providers or health plan staff.

Health Insurance Counseling and Advocacy Program (HICAP)

An advocacy agency that provides free and neutral information and counseling to help you understand your specific rights and health care choices.

Health Maintenance Organization (HMO)

A type of health plan where a group of doctors, hospitals, and other health care providers agree to give health care to members for a set amount of money every month. You usually must get your care from the providers in the plan, and your providers can usually share information and work together to give you care.

Health Plan

A group of doctors, specialists, clinics, pharmacies, hospitals, and long-term care providers that work together to meet your needs. Health plans are also called managed care plans. People enrolled in the health plan are called members and have a primary care provider who helps guide their health care.

Home- and Community-Based Services (HCBS)

Services and other supports that people can receive to help them stay in their home or community independently. HCBS services are typically paid for by Medi-Cal, for example:

  • In-Home Supportive Services.
  • Multipurpose Senior Services Program.
  • Community-Based Adult Services.
In-Home Supportive Services (IHSS)

The IHSS program provides in-home care for people who cannot safely remain in their own homes without assistance. These paid caregivers can assist with meal preparation, house cleaning, personal care services (such as bathing), and go with their clients to medical appointments. Your county assesses your IHSS needs, and your caregiver is paid for by Medi-Cal

In-Home Supportive Services (IHSS) Caregiver

An IHSS caregiver is a specific type of caregiver that is paid for by the Medi-Cal In-Home Supportive Services (IHSS) program. If you have an IHSS caregiver, you as the consumer choose, hire, supervise, and train your caregiver to meet your needs. You may also fire the caregiver for any reason. IHSS caregivers are paid for by Medi-Cal, but can still be a friend, relative, or professional.

Long-Term Services and Supports (LTSS)

A variety of services aimed at helping people with daily living activities. LTSS services include personal care, complex care, and help with housekeeping and other supportive services. This help can be provided in a nursing or other long-term care facility, or in the community as a home- and community-based service (HCBS). For examples of LTSS, see:

  • In-Home Supportive Services.
  • Multipurpose Senior Services Program.
  • Community-Based Adult Services.
Medi-Cal

California’s Medicaid program. Medi-Cal offers health coverage for low-income Californians.

Medical Equipment

This is equipment ordered or prescribed by your doctor to use at home. Medical equipment is reusable, and examples are walkers, wheelchairs, and hospital beds. When you’re in a nursing facility, your equipment is provided by your facility. Also known as Durable Medical Equipment (DME).

Medical Supplies

Supplies that are typically disposable, single use, medically-related, and often ordered or prescribed by a physician. Some examples include diabetic supplies, oxygen supplies, and incontinence supplies. When you’re in a nursing facility, your medical supplies are provided by your facility.

Medicare

The federal health program that provides health care benefits for people age 65 years or older, people age 65 years or younger with certain disabilities, and people with certain diseases. The different parts of Medicare are:

  • Part A covers medical care while you are at the hospital or during a short-term stay in a nursing facility.
  • Part B covers routine medical services such as doctor visits and preventative services. It also covers durable medical equipment (such as walkers), and laboratory services and supplies (like insulin pumps).
  • Part C is often called Medicare Advantage. It is a health plan that provides both Medicare Part A and Part B coverage, and sometimes Part D coverage.
  • Part D provides coverage for most prescription drugs through a health plan.
Medicare Advantage Plan (MA)

Get your Medicare from a health plan with extra benefits, keep your Medi-Cal separate, and get some help arranging your medical care.

Member

A term used to refer to a person who is enrolled in Medicare, Medi-Cal, or a health plan.

Mental Health Support

Behavioral health services that focus on mental health, for example counseling or medication you would receive to help with feelings of sadness or stress.

Multipurpose Senior Services Program (MSSP)

A program providing both health care and social services coordination. For people with Medi-Cal who are age 65 years or older and who are eligible for nursing facility care but are able to live in their home and community with extra help.

Network

A group of doctors, hospitals, pharmacies, and other health care professionals that work with your health plan to provide all your health care services.

Nursing Facilities

Nursing facilities include nursing homes and rehabilitation facilities and provide nursing, rehabilitative, and medical care. Medicare covers short-term nursing facility stays, for example if you need to stay at a nursing facility after a hospital stay before you are well enough to move home. Medi-Cal covers long-term nursing facility stays for people who can’t live safely at home.

Ombudsman

An organization or independent advocate that helps individuals access the care they need and can help health plan members resolve problems they are having with their health plan or related health care program.

Personal Care Support Services

Services you receive in a home to help with activities of daily living like getting in and out of bed, bathing, dressing, preparing meals and eating, and more. These services can be provided through the In-Home Supportive Services Program (IHSS) or through a home personal care agency.

Preferred Provider Organization (PPO)

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers that you use for services. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You may have to pay more if you use doctors, hospitals, and providers outside of the network.

Primary Care Provider

Your main health care provider. This may be a doctor, nurse practitioner, nurse midwife, or physician’s assistant. They help connect you to all the services you need, including care from specialists.

Private Fee-for-Service (PFFS)

A Medicare PFFS Plan is a type of health plan offered by a private insurance company and is not the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Program of All-Inclusive Care for the Elderly (PACE)

Get your Medicare and Medi-Cal in one health plan with extra benefits like a PACE day center and Care Team. Get extra help to live in your home and community. For people who need extra help, age 55 years or older.

Provider

A person or organization that provides health care-related services, like a doctor, hospital, or clinic. 

Respite Care

Funding and/or support for primary caregivers to take a short-term break from caregiving. Respite care can range from hours to days and is provided in-home, at a health care facility, or at an adult day center.

Restorative Therapies

Physical, occupational, speech, and psychiatric treatment, provided to someone with a temporary or permanent disability with the goal of increasing, restoring, or maintaining function.

Substance Use Support

Behavioral health services that help people who use substances like alcohol or other drugs.

Transportation Benefits

Medicare covers emergency ambulance services. Medi-Cal provides transportation to non-emergency, medically-necessary services, like doctor visits or to pick up a prescription. If you need transportation provided by an ambulance or wheelchair van, you have access to those vehicles. And if a taxi, ride-share, or public transportation better suits your needs, you have access to that transportation as well.

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