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Medicare Annual Election Period: Glossary of Terms

Understanding the ABCs of Medicare is a must for receiving the coverage you deserve. The following breakdown of the terms related to Medicare should make it a little easier to navigate, especially during critical times like the Medicare Annual Election Period.

Medicare Program Terms

Original Medicare

Original Medicare is made up of Medicare Parts A and B. This pair of “fee-for-service” insurance plans cover doctor visits (Part A) and hospital stays (Part B). It is administered by the federal government and is available to most U.S. citizens 65 or older, as well as individuals who are disabled.

Medicare Advantage (Medicare Part C)

Medicare Advantage Plans bundle Medicare Parts A and B, often including additional benefits as well, such as vision, dental, hearing, fitness, and more. Medicare Advantage Plans are offered by private organizations, with oversight by the federal Centers for Medicare and Medicaid Services (CMS).

Medicare Prescription Drug Plans (Part D)

Part D Plans are privately managed insurance for prescription drugs. Part D Plans can supplement Original Medicare and Medicare Advantage Plans.

Medigap

Medigap plans, also called Medicare Supplement Plans, are managed by private organizations and offer additional insurance coverage for medical services not covered by Original Medicare.

Service area

Service area refers to a Medicare plan’s geographic reach. A plan’s service area may cover healthcare services or a selection of institutions within a set geographic area. The service area limitation is why Medicare plan eligibility is often narrowed down initially by your zip code.

Medicare Policy Terms

Assignment

A contract that establishes that your healthcare provider or medical supplier will accept direct payment from Medicare at a cost approved by Medicare.

Coinsurance

This is the portion you pay for healthcare services or equipment after you’ve met your plan’s deductible. It’s often a set percentage, but some providers may set a dollar amount instead.

Copayment

The portion you pay for healthcare services or equipment. It’s usually a dollar amount, rather than a percentage.

Cost sharing

The portion you pay for healthcare services and supplies covered by your insurance. Copayments and deductibles are examples of cost sharing.

Coverage gap

A period beyond the annual limit for prescription drug coverage. After exceeding a set dollar amount, you’ll have to pay more out of pocket. The coverage gap also has a limit, which is when catastrophic coverage begins and the out of pocket costs decrease. This is sometimes known as the “donut period,” because of the “hole” in coverage.

 

Keep reading the Medicare Annual Election Period: Glossary of Terms to learn more about Medicare terms and resources.