Medicare education
Medicare glossary
Common words you'll see, explained simply.
- Annual Enrollment Period (AEP)
- October 15 – December 7 each year, when you can join, switch, or drop a Medicare Advantage or Part D plan.
- Coinsurance
- Your share of the cost of a covered service, shown as a percentage (for example, 20%).
- Copay
- A fixed dollar amount you pay for a covered service, like $20 for a doctor visit.
- Creditable coverage
- Other health or drug coverage that is at least as good as Medicare’s. Having it can protect you from late penalties.
- Deductible
- The amount you pay for care before your plan begins to pay.
- Dual eligible
- Someone who has both Medicare and Medicaid.
- Extra Help
- A federal program that helps people with limited income pay for Part D drug costs. Also called the Low-Income Subsidy.
- Formulary
- The list of prescription drugs a plan covers.
- HMO
- Health Maintenance Organization. A plan that usually requires you to use in-network doctors and get referrals for specialists.
- Initial Enrollment Period (IEP)
- Your first chance to sign up for Medicare: a 7-month window around your 65th birthday.
- Medicare Advantage (Part C)
- A private plan approved by Medicare that bundles Part A, Part B, and usually Part D.
- Medicare Supplement (Medigap)
- Private insurance that helps pay costs Original Medicare doesn’t, like coinsurance and deductibles.
- Network
- The doctors, hospitals, and pharmacies a plan contracts with.
- Original Medicare
- Part A and Part B, run by the federal government.
- Out-of-pocket maximum
- The most you’ll pay in a year for covered services in a Medicare Advantage plan.
- PPO
- Preferred Provider Organization. A plan with a network, but you can go out-of-network for a higher cost.
- Premium
- The amount you pay each month to have coverage.
- Scope of Appointment (SOA)
- A form you sign before a sales meeting that lists which types of products you want to discuss.
- SHIP
- State Health Insurance Assistance Program. Free, unbiased Medicare counseling in every state.
- Special Enrollment Period (SEP)
- A time outside normal windows when a life event lets you change coverage.