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Reviewed for accuracy by Lauri Middleton, RN, MSN, licensed Medicare agentReviewed for clarity by Karen OrillaMeet our reviewers →
Glossary
Glossary
The words Medicare uses, in plain language.
Plain words for the terms Medicare uses. Every term links to where it matters.
The parts of Medicare
- Part A
- Hospital insurance: inpatient stays, skilled nursing after a hospital stay, hospice, some home health. Most people pay no premium for it.
- Part B
- Medical insurance: doctor visits, outpatient care, tests, equipment, preventive services. Has a monthly premium, and a late-enrollment penalty if you sign up late without job coverage.
- Part C (Medicare Advantage)
- Private plans that bundle Parts A and B, usually drug coverage, and often extras. Networks and rules differ from Original Medicare.
- Part D
- Prescription drug coverage, bought as a stand-alone plan or inside a Medicare Advantage plan. Each plan has its own drug list.
- Original Medicare
- Parts A and B run by the federal government. Any provider that accepts Medicare, anywhere in the country. No drug coverage unless you add Part D.
Windows and deadlines
- Initial Enrollment Period (IEP)
- The seven months around your 65th birthday month: three before, the month itself, three after.
- Special Enrollment Period (SEP)
- A window opened by an event — job coverage ending, a move, losing other coverage. Each has its own length and start.
- General Enrollment Period (GEP)
- January 1 to March 31 each year: the fallback for signing up for Part B when no other window applies.
- Open Enrollment (AEP)
- October 15 to December 7 each year: when anyone with Medicare can join, switch or drop a Medicare Advantage or Part D plan for January.
- Annual Notice of Change (ANOC)
- The letter your plan must send by September 30 listing what changes next year: costs, drugs, doctors, benefits.
Costs
- Deductible
- What you pay before coverage starts paying, each year or each benefit period.
- Copay and coinsurance
- A copay is a fixed amount per visit or prescription. Coinsurance is a percentage of the cost.
- IRMAA
- An extra Part B and Part D premium for higher incomes, based on the tax return from two years ago. It can be appealed after a life change.
- Late enrollment penalty
- A permanent addition to the Part B or Part D premium for signing up late without qualifying coverage.
- Creditable coverage
- Drug coverage at least as good as standard Part D. Having it means no Part D penalty later. Your employer must tell you each year whether yours is creditable.
Plans and choices
- Medigap (Medicare Supplement)
- A private policy that pays some of what Original Medicare leaves you to pay. Standardized plan letters; California adds a yearly birthday rule.
- Network
- The doctors, hospitals and pharmacies a plan has agreements with. Going outside it can cost more or not be covered.
- Formulary
- A plan's list of covered drugs, with tiers and rules. It can change each year.
- Prior authorization
- Approval a plan requires before it will pay for some services or drugs.
- Service area
- The counties where a plan is offered. Moving out of it opens a Special Enrollment Period.
Help and rights
- HICAP
- California's free, confidential Medicare counseling program. Counselors do not sell insurance.
- Extra Help
- A federal program that lowers Part D premiums and drug costs for people with limited income. Applied for through Social Security.
- Medicare Savings Programs
- State programs, run through your state Medicaid office, that pay the Part B premium and sometimes more.
- SHIP (State Health Insurance Assistance Program)
- Free, unbiased Medicare counseling in every state. Counselors do not sell insurance.
- Medicare Summary Notice (MSN)
- The notice Original Medicare mails every three months listing claims, what Medicare paid and what you may owe. It is not a bill.
- Appeal
- The formal way to ask Medicare or a plan to reconsider a denial. Every denial notice states the deadline.
- Helper or caregiver
- Someone who helps a person with Medicare understand choices. The person with Medicare, or their legal representative, makes the decisions.