Medicare Glossary

A

Annual Election Period (AEP): The time from October 15 to December 7 each year when you can enroll in or change your Medicare Advantage or Medicare Part D plan.

Appeal: A request for your Medicare plan to reconsider a decision to deny coverage for a service or item.

B

Beneficiary: A person who has health insurance through the Medicare program.

Benefit Period: The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you are admitted to a hospital or skilled nursing facility and ends when you have not received any inpatient care for 60 days in a row.

C

Catastrophic Coverage: After you have spent a certain amount of out-of-pocket costs for covered drugs, you reach catastrophic coverage. During this phase, you pay a small coinsurance or copayment for covered drugs for the rest of the year.

Centers for Medicare & Medicaid Services (CMS): The federal agency that runs the Medicare program.

Coinsurance: The percentage of the cost of a covered healthcare service you pay after you have paid your deductible.

Copayment: A fixed amount ($20, for example) you pay for a covered healthcare service after you have paid your deductible.

D

Deductible: The amount you must pay for healthcare or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Donut Hole (Coverage Gap): A period in Medicare Part D coverage where you may pay more out-of-pocket for prescription drugs until you reach catastrophic coverage.

E

Extra Help: A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, such as premiums, deductibles, and coinsurance.

F

Formulary: A list of prescription drugs covered by a Medicare Part D plan.

G

Gap Coverage: See "Donut Hole."

H

Health Maintenance Organization (HMO): A type of Medicare Advantage Plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.

I

Initial Enrollment Period (IEP): The seven-month period when you can first sign up for Medicare (three months before you turn 65, the month you turn 65, and three months after you turn 65).

L

Late Enrollment Penalty: An amount added to your Medicare Part B or Part D premium if you do not sign up when you are first eligible.

M

Medicare Advantage Plan (Part C): A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.

Medicare Part A: Hospital insurance that covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B: Medical insurance that covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C: See "Medicare Advantage Plan."

Medicare Part D: Prescription drug coverage that helps cover the cost of prescription drugs.

Medigap: Medicare Supplement Insurance sold by private companies to help pay some of the healthcare costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles.

N

Network: The facilities, providers, and suppliers your health insurer or plan has contracted with to provide healthcare services.

O

Original Medicare: The traditional fee-for-service program offered directly through the federal government, consisting of Part A and Part B.

P

Preferred Provider Organization (PPO): A type of Medicare Advantage Plan that offers more provider flexibility and does not require referrals for specialist services.

Premium: The periodic payment to Medicare, an insurance company, or a healthcare plan for health or prescription drug coverage.

Prescription Drug Plan (PDP): A stand-alone Medicare Part D plan that adds prescription drug coverage to Original Medicare and some other Medicare plans.

S

Skilled Nursing Facility (SNF): A facility with the staff and equipment to provide skilled nursing care or rehabilitation services.

Special Enrollment Period (SEP): A time outside the usual enrollment periods when you can sign up for Medicare, such as after losing job-based insurance.

T

Trust Fund: Two separate funds held by the U.S. Treasury (Hospital Insurance and Supplementary Medical Insurance) that pay for Medicare Part A and Part B services.

U

Urgent Care: Care you get for a sudden illness or injury that isn't life-threatening but needs to be treated before you can wait for a regular doctor's appointment.

We hope this glossary helps you navigate your Medicare options with confidence. If you have any questions or need further assistance, please feel free to contact us.