Resources
Medicare glossary
The terms you will run into, translated. No acronym left unexplained.
- AEP (Annual Enrollment Period)
- October 15 to December 7 each year, when anyone on Medicare can change Advantage and drug plans for the coming year.
- Coinsurance
- Your percentage share of a covered cost. Under Original Medicare Part B, typically 20 percent.
- Copay
- A fixed dollar amount you pay for a covered service, like $10 for a doctor visit.
- Deductible
- What you pay out of pocket before your coverage starts paying.
- Formulary
- The list of drugs a Part D or Advantage plan covers, organized into pricing tiers.
- IEP (Initial Enrollment Period)
- Your first 7-month enrollment window, wrapped around your 65th birthday month.
- IRMAA
- Income-Related Monthly Adjustment Amount: a surcharge added to Part B and Part D premiums for higher-income households.
- Medicare Advantage (Part C)
- Private plans that deliver your Part A and B benefits, usually with drug coverage and extra benefits, in exchange for network rules.
- Medigap (Medicare Supplement)
- Standardized private plans that pay the costs Original Medicare leaves behind. Sold by plan letter (Plan G, Plan N, etc.).
- Network
- The doctors, hospitals and pharmacies a plan has contracted with. Going outside it can cost more or not be covered.
- Out-of-pocket maximum
- The annual cap on what you pay under a Medicare Advantage plan. Original Medicare has no cap.
- Part D penalty
- A permanent premium surcharge for going 63+ days without creditable drug coverage after becoming eligible.
- Prior authorization
- A plan requirement that a service be approved in advance to be covered.
- SEP (Special Enrollment Period)
- A personal enrollment window triggered by life events like moving or losing employer coverage.
- Underwriting
- A carrier reviewing your health before issuing coverage. Applies to Medigap outside protected windows in most states.
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