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Reviewed for accuracy by Lauri Middleton, RN, MSN, licensed Medicare agentReviewed for clarity by Karen OrillaMeet our reviewers →
Glossary
Plain words for the terms Medicare uses.
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.
Get help
Free Medicare counseling
California HICAP offers free, confidential Medicare counseling. Ask the local program about language and appointment availability.
California HICAP1-800-MEDICARE
Call 1-800-MEDICARE and ask for an interpreter. TTY: 1-877-486-2048.
Call Medicare · 1-800-633-4227Official information in other languages ↗External resource. Some pages are in English; ask for language assistance if needed.