Medicare Glossary: Simplifying the Language of Healthcare Coverage
Why Understanding Medicare Matters
Medicare can be confusing — with multiple parts, plans, and rules that affect both coverage and cost. At Insure Your Success, we simplify the complexity so you can make informed choices that protect your health and your finances. Understanding these terms will help you maximize benefits and avoid costly mistakes during your Financial Assessment → Financial Analysis → Strategy Design process.
Top 3 Trending Terms
1. Medicare Advantage (Part C)
A private plan alternative to Original Medicare that often includes prescription, vision, and dental coverage.
Pro Tip: Medicare Advantage can reduce out-of-pocket expenses and simplify coverage — perfect for those who prefer one integrated plan.
2. Medigap (Medicare Supplement)
Additional insurance that covers costs not paid by Original Medicare, such as copayments and deductibles.
Pro Tip: Medigap is ideal for retirees seeking predictable healthcare expenses and nationwide provider access.
3. Prescription Drug Coverage (Part D)
Covers the cost of prescribed medications under Medicare.
Pro Tip: Reviewing your Part D plan annually ensures your medications remain affordable as formularies change.
A - Z Medicare Glossary (30 Core Terms)
1. Annual Enrollment Period (AEP): The yearly window (Oct 15–Dec 7) to change Medicare coverage.
2. Assignment: When a doctor accepts Medicare’s approved amount as full payment.
3. Beneficiary: A person enrolled in Medicare and eligible for benefits.
4. Catastrophic Coverage: The highest level of coverage under Part D after reaching spending thresholds.
5. Coinsurance: The percentage you pay after meeting your deductible.
6. Copayment: A fixed amount you pay for healthcare services or prescriptions.
7. Creditable Coverage: Non-Medicare insurance that is equal or better than Medicare’s prescription coverage.
8. Deductible: The amount you pay before Medicare starts covering costs.
9. Durable Medical Equipment (DME): Equipment like wheelchairs or oxygen used for medical purposes.
10. Extra Help: A federal program that assists low-income individuals with Part D costs.
11. Formulary: The list of drugs covered by a Part D plan.
12. Guaranteed Issue Rights: Rights that protect you when enrolling in a Medigap plan under certain conditions.
13. Hospital Insurance (Part A): Covers inpatient hospital care, skilled nursing, and hospice.
14. Initial Enrollment Period (IEP): The seven-month window around your 65th birthday to enroll in Medicare.
15. Late Enrollment Penalty: A fee added for enrolling in Part B or Part D after your initial eligibility.
16. Lifetime Reserve Days: Extra hospital days Medicare pays for after standard benefits are used.
17. Medigap: Supplemental insurance to fill coverage gaps in Original Medicare (see Top 3 Terms).
18. Medicare Advantage (Part C): Private insurance plans that combine Parts A, B, and often D (see Top 3 Terms).
19. Medicare Savings Programs (MSPs): State programs that help with Medicare premiums and out-of-pocket costs.
20. Network: A group of doctors and hospitals contracted with a Medicare Advantage plan.
21. Open Enrollment Period (OEP): A specific time each year to switch or adjust Medicare Advantage plans.
22. Out-of-Pocket Maximum: The most you’ll pay in a year for covered services.
23. Part A: Hospital coverage under Original Medicare.
24. Part B: Medical coverage for doctor visits, preventive care, and outpatient services.
25. Part C: Medicare Advantage plans offered by private insurers.
26. Part D: Prescription drug coverage (see Top 3 Terms).
27. Premium: The monthly amount you pay for your plan.
28. Prior Authorization: A requirement for insurer approval before certain services are covered.
29. Skilled Nursing Facility (SNF): Provides rehabilitation and medical care after hospitalization.
30. Special Enrollment Period (SEP): Allows plan changes outside of standard enrollment periods for qualifying life events.
Now that you understand the essentials of Medicare, let’s ensure your coverage aligns with your financial goals. Start your Medicare Readiness Assessment today and gain clarity on which plan best fits your health, budget, and retirement strategy.