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Understanding Medicare Terminology | Healthcare Glossary


Ancillary policies: This phrase refers to privately-offered plans outside of the Medicare basics (Original Medicare and Medicare Advantage). Ancillary plans can include Medicare Supplements, cancer policies, stand-alone dental or vision, etc.

Annual Enrollment Period (AEP): Runs from October 15 through December 7 each year. Anyone eligible for Medicare can enroll during this time.

ANOC (Annual Notice of Change): Annual letter from your plan telling you if any costs or benefits have changed. This will arrive in early fall so that you can decide whether or not you want to make a change during the Annual Enrollment Period that begins in October.

Area Agency on Aging (AAA): Local agencies that can offer you services such as “meals on wheels,” help you find home health providers, and even provide support to your family and caregivers.

COBRA: Requires your employer to let you keep your healthcare coverage for a limited time after you are fired to help you avoid a lapse in coverage.

Coinsurance: The amount of the medical service that you are responsible for.

Co-payment: The fee you pay upon visiting a doctor, buying a prescription, etc.

CSNP (Chronic Condition Special Needs Plan): A type of Medicare Advantage plan for those with a number of qualifying conditions.

Deductible: The amount you have to pay before your coverage begins.

Dependents: This does not apply to Medicare. Traditionally, dependents are the people who are “dependent” on you and your health care plan. This could be a child, spouse, etc.

Donut Hole: A gap in prescription drug coverage that almost every Medicare beneficiary will face.

Durable Medical Equipment: Prescribable healthcare devices that Medicare Part B provides coverage for. This includes medically necessary items like crutches, wheelchairs, infusion pumps, blood sugar monitors, etc.

Extra Help (LIS, Low-Income Subsidies): Program to help eligible Medicare beneficiaries save money on prescription drugs.

Federal Poverty Level: Every year, the government releases a new chart which determines eligibility for government programs like Medicaid (not Medicare) and food stamps. It is based on income and number of household members.

Formulary: The list of drugs that your plan covers. Usually separated by tier according to cost.

General Enrollment Period: If you miss your Initial Enrollment Period, this is when you can sign up for Medicare. It runs from January 1 through March 31 and is only for first-time enrollees.

HMO (Health Maintenance Organization) Plan: A form of Medicare Advantage with which you are required to select one primary physician who you turn to first for all your healthcare needs. That doctor can refer you to specialists if necessary.

Hospice: Pain management, counseling, hospital care, and more for terminally ill patients. Included in Medicare Part B coverage.

HSA (Health Savings Account): Bank account installed by your insurance company. You can put tax-free money into this account on a regular basis (like a basic savings account) and can use the money for healthcare expenses.

Initial Enrollment Period: Starts three months before your 65th birthday and ends three months after. This is the time that most people will enroll in Medicare.

In-network: When a provider (doctor, hospital, pharmacy, etc.) is in-network, he or she accepts your plan and you will be covered when you see that provider.

ISNP (Institutionalized Special Needs Plan): A type of Medicare Advantage plan for those living in nursing home institutions.

Medicare Advantage (Medicare Part C): A privately-owned Medicare plan that covers everything that Original Medicare includes but is allowed to bundle in additional benefits like prescription drugs, dental, vision, fitness, etc. You may also see the term “MAPD,” referring to Medicare Advantage plans with prescription drug coverage.

Medicare Part A: Part of Original Medicare. Covers hospital-related services.

Medicare Part B: Part of Original Medicare. Covers doctor-related services.

Medicare Savings Programs: Eligible Medicare beneficiaries can save money on premiums, copayments, and deductibles with this program.

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Medicare Supplements: A separate, private insurance plan that can help you pay your Medicare premiums, deductibles, and copayments. This is not a Medicare replacement.

Open Enrollment Period (OEP): Runs from January 1 through March 31. Only for switching between Medicare Advantage options.

Out-Of-Pocket Limit: Some plans place this maximum dollar amount that you can spend out of your own pocket on your Medicare. Usually, if you surpass your out-of-pocket limit, your medical expenses will be 100% covered.

PDP (Part D): Privately-owned prescription drug plan. Only includes covers for drugs.

Policyholder: The plan is under this person’s name.

POS (Point-Of-Service) Plan: A type of Medicare Advantage plan with which you will have a small network of providers (doctors, hospitals, pharmacies, etc.) to choose from.

PPO (Preferred Provider Organization) Plan: A type of Medicare Advantage plan with which you can see any doctor, but some will be preferred and will be much cheaper for you.

Premium: The regular payment you are responsible for to keep your insurance plan. This is usually a monthly fee.

Silver & Fit: A private fitness program for seniors that provides gym memberships and classes. Included in some Medicare Advantage plans.

SilverSneakers: Another private fitness program for seniors that provides gym memberships and classes. Included in some Medicare Advantage plans.

Special Enrollment Period (SEP): People with special circumstances can enroll in Medicare plans outside of the traditional enrollment periods.

Special Needs Plans: Medicare Advantage plans for Medicare beneficiaries with special financial or health care needs. Includes QMB, QMB+, SLMB, QI, QDWI, FBDE, ISNP, and CSNP. Click to learn more about each type.

TRICARE: Health benefits for active duty and retired servicemembers and their families.

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