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Medicare 101: Terms You Should Know When Reviewing Your Plan

Medicare form with terms

When you enroll in Medicare, it is something like learning a new language. There are a number of terms you will need to learn to understand the process of enrollment and how your plan works. The following are some Medicare terms you will need to know when you review your plan.

  • Part A: Medicare hospital insurance
  • Part B:Medicare doctor and outpatient insurance
  • Part C: Medicare Advantage Plans offered by private insurance companies
  • Part D: Medicare prescription drug coverage
  • Original Medicare: Part A and Part B together
  • Medicare Advantage Plans (MAPs): Health plans offered by private insurance companies in accordance with specific requirements established by Medicare
  • Part B premium: The monthly amount you pay for your health coverage, whether you have Original Medicare or a Medicare Advantage Plan (some Medicare Advantage Plans charge additional premiums)
  • Penalty: An amount added to your Part B and/or Part D premiums for as long as you have Medicare, with some exceptions, if you fail to enroll when you are first eligible for Medicare
  • Deductible: A set amount you will have to pay out-of-pocket for healthcare expenses before your plan kicks in
  • Copay: A fixed amount you pay at the time of a covered service
  • Coinsurance: The percentage you pay when you split the cost of a service with your plan
  • Annual election period (AEP): The enrollment period from October 15 through December 7 of every year during which individuals eligible for Medicare Advantage Plans may enroll in or disenroll from a Medicare Advantage Plan
  • Medigap: Medicare supplement coverage sold by private insurance companies to fill the gaps in Original Medicare coverage
  • Out-of-pocket maximum: The maximum amount in a calendar year that you pay out-of-pocket toward the costs of covered healthcare, including deductibles and copayments
  • Primary care physician (PCP): A doctor who is trained to provide your basic care, who you see first for most health problems, and who refers you to specialists if necessary, under an HMO
  • Health maintenance organization (HMO): A type of Medicare Advantage Plan that requires you to go to a specific network of doctors, hospitals, and specialists (except in an emergency), to choose a primary care physician (PCP), and to get a referral from your PCP before you see a specialist
  • Referral: A written order from your primary care physician for you to see a specialist or receive certain services, without which the plan may not cover your care
  • Preferred provider organization (PPO): A type of Medicare Advantage Plan that allows you to use doctors, hospitals, and healthcare providers outside of the plan’s network, although you pay more if you go out of network, and does not require you to choose a PCP or get a referral
  • Preventative health services: Healthcare that helps prevent illness, such as annual physical exams, flu shots, mammograms, and blood pressure, cholesterol, and diabetes testing

Signing up for Medicare can be a confusing experience. If you need assistance reviewing your Medicare plan, our experienced agent is happy to help.

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