Medicare Terms To Know

Reviewed and Updated by Anastasia Iliou,

There’s nothing wrong with not knowing what certain words mean when you’re looking into healthcare. A lot of the terms and phrases are ones that you would never see anywhere else! Medicare and all its parts can be confusing, but that’s why we’re here. These are some of the Medicare terms that we want to help you understand.

Ancillary – A policy that is not Original Medicare or Medicare Advantage (Medicare Supplements, cancer policies, and dental policies are just some examples). You can usually enroll at any time

COBRA –An act that requires your employer to keep your healthcare coverage for a limited time after you are fired to help you avoid a lapse in coverage

Coinsurance – The healthcare costs that you are personally responsible for

Copayment – The amount you pay out of pocket when you visit your doctor or purchase a prescription

Deductible – The amount you have to spend before your coverage kicks in

Dependents – Family members who can benefit from your plan (does not apply to Medicare)

HMO (Health Maintenance Organization) Plan – You will need to select one primary physician to turn to for all of your healthcare needs and can only see another provider if you have an official referral

HSA (Health Savings Account) – A separate bank account set up by your insurer that allows you to set aside tax-free money to use for healthcare expenses

In-network – A provider that is in agreement that your plan will provide coverage for the services that you receive there

Medicare Advantage – A Medicare plan offered by private insurers (not government-owned) that includes all Medicare benefits PLUS additional benefits like prescription drugs, dental, vision, hearing, fitness, etc.

Medicare Supplements – If you have Original Medicare only, you can add a Medicare Supplement plan to help you pay for your premiums, deductibles, and copayments

Out-Of-Pocket Limit – The maximum dollar amount you will be responsible for paying for your healthcare

Policyholder – The person whose name is on the plan

POS (Point-Of-Service) Plan – You will have a small network of providers to choose from but will be able to see any of those providers instead of choosing just one

PPO (Preferred Provider Organization) Plan – You can see any doctor, but some will be significantly cheaper for you than others

Premium – The regular payment (usually monthly) you are responsible for to keep your coverage

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