Welcome to our Medicare Key Terms page, your one-stop resource for understanding the terminology and jargon associated with Medicare. Medicare, the federal health insurance program in the United States, can be complex. However we’re here to simplify it for you.
On this page, you’ll find clear and concise explanations of essential Medicare terms. What are “Part A” and “Part B,” “Medicare Advantage,” “Medigap?”. Whether you’re new to Medicare, helping a loved one navigate the system, or just looking to brush up on your knowledge, our comprehensive glossary will demystify the language of Medicare.
- Medicare: A federal health insurance program in the United States that provides coverage to individuals aged 65 and older. As well as certain younger individuals with disabilities.
- Medicare Part A: Hospital Insurance. It covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Medicare Part B: Medical Insurance. It covers doctor’s services, outpatient care, medical supplies, and preventive services.
- Medicare Part C: Also known as Medicare Advantage. It’s offered by private insurance companies approved by Medicare and provides Part A and Part B benefits. Often with additional coverage like prescription drugs and wellness programs.
- Medicare Part D: Prescription Drug Coverage. It helps pay for prescription drugs, offered through private insurance companies.
- Medigap: Medicare Supplement Insurance. Policies sold by private insurance companies to cover the “gaps” in Original Medicare. Such as copayments, deductibles, and other out-of-pocket costs.
- Open Enrollment Period: A specific time each year when you can make changes to your Medicare coverage, like switching between Original Medicare and Medicare Advantage.
- Special Enrollment Period (SEP): Occurs outside the regular enrollment periods and is available to those who experience specific life events, like moving, losing other coverage, or qualifying for Medicaid.
- Medicare Advantage Plan: Health plans offered by private companies that provide Medicare Part A and Part B coverage, often with additional benefits like dental, vision, and prescription drug coverage.
- Original Medicare: Refers to Medicare Part A and Part B provided by the federal government.
- Medicare Cost Plans: A type of Medicare health plan available in certain areas that allows you to get services from Original Medicare or a Medicare Advantage Plan.
- Beneficiary: An individual who is eligible for and receives Medicare benefits.
- Premium: The amount you pay for your Medicare coverage, typically on a monthly basis.
- Copayment: A fixed amount you pay for a covered service, such as a doctor’s visit or prescription medication.
- Deductible: The amount you must pay for covered health care services before Medicare or your Medicare plan starts to pay.
- Out-of-Pocket Maximum: The most you have to pay for covered services in a plan year. Once you reach this amount, the plan covers your eligible costs in full.
- Medicare Part C Maximum Out-of-Pocket (MOOP): The maximum limit on out-of-pocket costs for services covered under a Medicare Advantage plan in a given year.
- Medically Necessary: Services or items that are required for the diagnosis or treatment of a medical condition and meet accepted standards of medical practice.
- Preventive Services: Healthcare services that focus on disease prevention, including vaccinations, screenings, and annual wellness visits.
- Medicare Summary Notice (MSN): A quarterly statement that provides a summary of Medicare Part A and Part B claims, including what Medicare paid and what you owe.
- CMS (Centers for Medicare & Medicaid Services): The federal agency responsible for administering the nation’s major healthcare programs, including Medicare and Medicaid.
- Medicaid: A joint federal and state program that provides health coverage to low-income individuals and families.
- Extra Help (Low-Income Subsidy): A program that helps people with limited income and resources pay for prescription drug costs associated with Medicare Part D.
- Part D Late Enrollment Penalty: A financial penalty imposed on individuals who don’t enroll in a Medicare Part D plan when they are first eligible and then later decide to enroll.