Medicare Glossary
Find definitions for key terms used related to Medicare Advantage, Medicare Supplement, and Prescription Drug Plans
The Medicare Advantage and Prescription Drug Plan Annual Election Period (AEP) is the time in which individuals seeking Medicare health insurance coverage may either apply for a new policy or renew an existing policy each year. The period typically runs from October 15th to December 7th every year.
A medication that is distributed under a trademarked brand name.
A period of time during which a Medicare-insured individual is covered for all healthcare received. It starts when the insured is admitted to a hospital or short-term care facility and ends when the individual has been home for a consecutive number of days specified by the type of Medicare plan that they’re enrolled in.
The pre-determined percentage of each medical bill that the insured is responsible for paying out of their pocket.
The pre-determined dollar amount, or “co-pay,” for healthcare service that the insured is responsible for paying out of their pocket at the time they receive the service.
When the insured and Medicare share or split the cost of the insured’s healthcare. Cost-sharing levels are provided in a plans summary.
A temporary limit on what most Medicare Part D Prescription Drug plans pay for prescription drug costs.
The pre-determined amount of medical care or services that the insured must pay out-of-pocket before their health insurance plans will begin covering healthcare costs.
The document that outlines the cost-sharing costs or all drugs covered by a plan.
The dates in which individuals who missed their initial enrollment period can enroll. The General Enrollment Period is from January 1 to March 31st each year.
A medication that is not distributed by a trademarked brand name, but that has the same active ingredients and functions the same way as a brand name medication.
A plan that requires the insured to obtain healthcare services only from service providers and hospitals that participate in the plan’s network. Should the insured choose to obtain healthcare from a provider or hospital outside of the network, all ensuing medical bills will not be covered by the insured’s plan.
Covered care, including pain and symptom management, that is provided either in a Hospice facility or at home to insured individuals who are terminally ill.
The dates on which eligible individuals seeking Medicare health insurance coverage for the first time may apply for a new policy. Typically, this period starts three months before the month that the insured turns 65 and ends three months after the insured’s 65th birthday (totaling 7 months).
Healthcare and services that the insured receives during the time that they are admitted to the hospital.
A financial assistance program that’s offered to low-income individuals. Medicaid helps Medicare cover a Medicaid-covered individual’s premiums, deductibles, copayments, and co-insurance.
A savings account from the insured’s bank that is combined with a Medicare Advantage plan. The insured may only use any funds in the account for healthcare services.
A Medicare Advantage plan, also known as Medicare Part C, is a health plan offered by private insurance companies contracted with Medicare that provide the same coverage as parts A and B of Original Medicare. When you enroll in a Medicare Advantage Plan most of your Original Medicare health services will be provided by and managed by your plan.
The Medicare Part D plan that covers the insured’s applicable prescription medications.
Another term that may be used to describe supplemental Medicare insurance.
The period of January 1 through February 14, when an individual who is currently covered by a Medicare Advantage plan may disenroll from their plan.
A Medicare plan that combines a savings account from the insured’s bank with a Medicare Advantage plan. The insured may only use any funds in the account for healthcare services.
The service providers, hospitals, and pharmacies that agree to participate in a Medicare plan’s network and to provide care for individuals insured under the plan.
The amount that the insured’s Medicare policy will not cover and that the insured must pay themselves through copayments, co-insurance, and deductibles.
The maximum amount that an individual covered by a Medicare Advantage plan will have to spend of their own money for medical expenses throughout the course of the plan year.
A reference to the Medicare Part A plan, which is the part of the original Medicare plan that provides coverage for healthcare received during a hospital stay and/or during time spent in a skilled nursing facility.
A reference to the Medicare Part B plan, which is the part of the original Medicare plan that provides coverage for healthcare received during doctor’s appointments and other medical services provided on an out-patient basis.
A reference to the Medicare Part C plan, which is Medicare Advantage. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and include all the provisions of Medicare Part A and Part B plans.
A reference to the Medicare Part D plan, which is the part of the original Medicare plan that provides assistance for prescription drugs. Part D plans are offered by private insurance companies contracted with Medicare.
A Medicare Advantage plan that allows the insured individuals to receive healthcare from providers and hospitals outside of the plan’s network. These plans typically have a higher copayment or coinsurance than other plans that only cover services provided by in-network providers.
A medical condition or illness that the insured has prior to applying for coverage for a Medicare plan.
A Medicare Advantage plan that lets insured individuals obtain healthcare from both in-network and out of network service providers and hospitals. Similarly to POS plans, obtaining healthcare services from out-of-network providers will most likely result in an increased out-of-pocket expense to the insured.
The monthly or annual payment that the insured pays in order to maintain coverage from their healthcare plan or program.
The Medicare Part D plan, which provides assistance for prescription drugs. Part D plans are offered by private insurance companies contracted with Medicare.
A healthcare service that helps to prevent an illness or that helps detect illness at an early stage. Examples of preventative care include a flu shot or diabetes screening.
A type of Medicare Advantage plan that lets the insured obtain healthcare from any service provider or hospital that is eligible under the provisions of the insured’s Medicare plan. The plan determines how much it will pay providers and how much you must pay when you get care. The treating doctor has to accept the plan’s payment terms and agree to treat you. If the doctor doesn’t agree to those terms, then the PFFS plan will not cover services through that doctor.
A physician, hospital, pharmacy, or other medical healthcare service provider.
The geographic area (typically a county, state, or region) where a network of providers performs their healthcare services.
Any type of healthcare that’s performed by a registered nurse.
An enrollment period where an individual may enroll in Medicare outside of regular enrollment periods due to extenuating circumstances.
A Medicare Advantage plan especially for people who have certain special needs such as beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions.