Medicare Glossary: Common Medicare Terms You Need to Know

A federal assistance program that helps eligible individuals with limited income pay Medicare Part D premiums, deductibles, and prescription drug copayments.

The list of prescription medications covered by a Medicare Part D plan or Medicare Advantage Prescription Drug plan. Drugs are typically organized into cost-sharing tiers.

Running from January 1 through March 31, this enrollment period allows individuals who missed their Initial Enrollment Period to sign up for Medicare Part A and/or Part B. Late enrollment penalties may apply in some situations.

Special protections that allow individuals to purchase certain Medicare Supplement (Medigap) plans without answering health questions or undergoing medical underwriting under specific circumstances.

A type of Medicare Advantage plan that generally requires members to use a network of participating doctors, specialists, and hospitals. Out-of-network services are typically not covered except in emergencies.

An insurance professional who represents multiple insurance companies rather than a single carrier. Independent agents can compare plans from various insurers to help clients find suitable coverage options.

The seven-month window when most people first become eligible for Medicare. It begins three months before your 65th birthday month, includes your birthday month, and continues for three months afterward.

An additional premium charged to higher-income Medicare beneficiaries for Medicare Part B and Part D coverage.

A Medicare-approved health plan offered by private insurance companies that combines Medicare Part A and Part B coverage into one plan. Many Medicare Advantage plans also include prescription drug coverage and additional benefits such as dental, vision, hearing, and fitness programs.

Hospital insurance that helps cover inpatient hospital stays, skilled nursing facility care, hospice services, and certain home healthcare services.

Medical insurance that helps cover doctor visits, outpatient care, preventive services, ambulance transportation, durable medical equipment, and medically necessary healthcare services.

Prescription drug coverage offered through private insurance companies. Part D plans may be purchased as standalone Prescription Drug Plans (PDPs) or included in Medicare Advantage plans.

State-administered programs that help eligible beneficiaries pay Medicare premiums and, in some cases, deductibles, copayments, and coinsurance.

Private insurance designed to help pay out-of-pocket costs not covered by Original Medicare, including deductibles, copayments, and coinsurance.

A hospital billing classification used when a patient is monitored in a hospital but is considered an outpatient rather than formally admitted as an inpatient. This designation can affect Medicare coverage and skilled nursing facility eligibility.

From January 1 through March 31, individuals enrolled in a Medicare Advantage plan may switch to another Medicare Advantage plan or return to Original Medicare and enroll in a standalone Part D plan.

The traditional federal Medicare program consisting of Medicare Part A and Medicare Part B coverage.

Additional charges some healthcare providers may bill above the Medicare-approved amount if they do not accept Medicare Assignment. Certain Medicare Supplement plans cover these charges.

A lifetime late enrollment penalty that may be added to your Medicare Part D premium if you delay enrolling without maintaining creditable prescription drug coverage.

Two of the most popular Medicare Supplement plans available to Medicare beneficiaries. While both help cover many out-of-pocket expenses associated with Original Medicare, they differ in premiums, copayments, and coverage details.

A type of Medicare Advantage plan that allows members to receive care from both in-network and out-of-network providers, typically with lower costs when using preferred providers.

The monthly amount you pay to maintain Medicare coverage or private Medicare insurance coverage.

A standalone Medicare Part D plan that provides prescription drug coverage for beneficiaries enrolled in Original Medicare.

Healthcare services intended to prevent illness or identify health concerns early, including annual wellness visits, screenings, vaccines, and preventive testing.

A requirement that certain medical services, procedures, treatments, or medications receive approval from the insurance plan before coverage is provided.

A popular fitness and wellness benefit offered through many Medicare Advantage plans and some Medicare Supplement plans. Benefits may include gym memberships, fitness classes, and wellness resources.

A Medicare enrollment opportunity triggered by certain qualifying life events, such as moving, losing employer coverage, or becoming eligible for Extra Help or Medicaid.

A Medicare Advantage plan specifically designed for individuals with certain chronic conditions, institutional care needs, or dual eligibility for Medicare and Medicaid.

A five-star quality rating system developed by CMS that helps beneficiaries compare Medicare Advantage and Part D prescription drug plans based on quality, performance, and member satisfaction.

The process insurance companies use to evaluate an applicant’s health history and determine eligibility for certain Medicare Supplement plans outside of guaranteed issue periods.