Medicare Glossary
Simple explanations of Medicare terms
part a
Hospital Insurance that covers inpatient care, skilled nursing, hospice, and some home health services.
part b
Medical Insurance that covers doctor visits, outpatient care, medical supplies, and preventive services.
part c
Medicare Advantage plans offered by private companies that include Part A and Part B coverage, often with extra benefits.
part d
Prescription Drug Coverage that helps pay for your medications.
medigap
Supplemental Insurance that helps pay for costs not covered by Original Medicare, like copays and deductibles.
initial enrollment
Your 7-month sign-up period that starts 3 months before your 65th birthday.
annual enrollment
October 15 to December 7 each year when you can change your Medicare coverage.
special enrollment
A time outside normal enrollment when you can change coverage due to certain life events.
deductible
The amount you pay for covered services before your insurance starts paying.
copay
A fixed amount you pay for a covered service, like $20 for a doctor visit.
coinsurance
Your share of costs for a covered service, calculated as a percentage (like 20%).
out of pocket maximum
The most you'll pay for covered services in a year. After this, the plan pays 100%.
moop
Maximum Out-of-Pocket limit - the most you'll pay for medical services in a year.
formulary
The list of prescription drugs covered by your plan.
network
The doctors, hospitals, and pharmacies that contract with your health plan.
in network
Providers who have agreed to accept your plan's payment rates.
out of network
Providers who haven't contracted with your plan, usually costing you more.
hmo
HMO (Health Maintenance Organization) - requires you to use doctors in the plan's network.
ppo
PPO (Preferred Provider Organization) - lets you see any provider but costs less in-network.
snp
SNP (Special Needs Plan) - Medicare Advantage plans for people with specific conditions.
original medicare
Traditional Medicare with Part A and Part B, run by the federal government.
medicare advantage
Private insurance plans that provide Medicare benefits, often with extra coverage.
star rating
A 1-5 star quality rating system that helps you compare Medicare plans.
extra help
A program that helps people with limited income pay for prescription drugs.
medicaid
State and federal program that helps with medical costs for people with limited income.
donut hole
Coverage gap in Part D where you pay more for drugs until catastrophic coverage begins.
creditable coverage
Drug coverage that's at least as good as Medicare Part D.
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