While the word Medicare itself may make sense, the words, terms, and phrases associated with this health insurance program can be a little more challenging. Discover the top terms that you’re likely to come across as you start thinking about enrollment.

Deductible

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Deductible:

The required amount that you must pay for your healthcare before insurance kicks in.

Claim
Claim:

A request for payment that you submit to Medicare when you believe a healthcare service should have been covered.

Copayment
Copayment:

A predetermined or set amount that you pay for medical services, such as a doctor’s visit.

Out-of-pocket maximum
Out-of-pocket maximum:

The most you have to spend for covered services in a plan year.

Coinsurance
Coinsurance:

An amount, usually a percentage, that you must pay for a medical service after your deductibles are met.

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Eligibility
Eligibility:

The requirements you must meet before enrolling in Medicare.

Enrollment period
Enrollment period:

The timeframe when you can change your Medicare coverage (October 15 - December 7).

Social Security
Social Security:

One of the three requirements for enrolling in Medicare: You must be 65 or older, receive Social Security Disability benefits, or have kidney failure to be eligible for Medicare.

Part A
Part A:

A plan that pays for inpatient care in a hospital or healthcare facility. Also known as hospital insurance.

Part B
Part B:

A plan that pays for doctors’ services and medical needs. Also known as medical insurance.

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Part C
Part C:

A plan offered by private companies that includes the benefits under Medicare Parts A and B, as well as prescription drug coverage (Medicare Part D) and other benefits. Also known as Medicare Advantage Plan.

Part D
Part D:

Also known as Prescription Drug Plan. Plans are tiered based on price and what medications are offered.

Medicare Advantage Plan
Medicare Advantage Plan:

A plan offered by private companies that includes the benefits under Medicare Parts A and B, as well as prescription drug coverage (Medicare Part D) and other benefits. Also known as Medicare Part C.

Prescription Drug Plan
Prescription Drug Plan:

Also known as Medicare Part D. Plans are tiered based on price and what medications are offered.

Supplemental benefits
Supplemental benefits:

Add-on or additional benefits besides the traditional Medicare coverage under Part A and Part B. Supplemental benefits include Part C and Part D.

HMO
HMO:

A plan offered by a private insurance company in place of Medicare Part A and Part B. It requires you to see your primary care doctor before seeing any specialist. It stands for Health Maintenance Organization.

PPO
PPO:

A plan offered by a private insurance company in place of Medicare Part A and Part B. Unlike an HMO, you can decide what doctors you want to see, including specialists, without a referral from your primary care doctor. It stands for Preferred Provider Organization.

HSA
HSA:

This is a tax exempt account designed to pay for medical expenses and needs. It stands for Health Savings Account.

FSA
FSA:

This is a tax-free or pre-tax account that you put money towards for the purpose of medical expenses and out-of-pocket healthcare costs. It stands for Flexible Spending Account.

HDHP
HDHP:

This insurance policy has a higher deductible but lower premium and combines a HSA or HRA with traditional medical coverage. It stands for High-Deductible Health Plan.

Insurance
Insurance:

A plan that covers the cost of medical needs and expenses. Medicare is the federal health insurance program for people over the age of 65, and those that meet other requirements.

Dental care
Dental care:

A service that typically isn’t covered by Medicare.

Vision
Vision:

Only preventive eye exams may be covered under Medicare Part B.

ALS
ALS:

Stands for Amyotrophic Lateral Sclerosis and is also known as Lou Gehrig’s disease. Those with this disease are eligible for Medicare, even if they’re not 65.

End-stage renal disease
End-stage renal disease:

One of the three requirements for enrolling in Medicare: You must be 65 or older, receive Social Security Disability benefits, or have kidney failure to be eligible for Medicare.

Catastrophic coverage
Catastrophic coverage:

A type of coverage that you automatically receive once you’ve spent the coverage gap under a Medicare prescription drug plan.

Provider
Provider:

The doctor or medical physician that gives care.

Exception
Exception:

A request for determining medical coverage.

Department of Health and Human Services
Department of Health and Human Services:

The federal agency that’s in charge of all healthcare matters for Americans, including Medicare, Medicaid, the Children’s Health Insurance Program, and the Marketplace.

Inpatient
Inpatient:

Coverage under Medicare Part A that includes hospitalizations and treatments.

Outpatient
Outpatient:

Coverage under Medicare Part B that includes emergency services and overnight hospital visits.

Premium
Premium:

A payment for health or prescription drug coverage.

Waiting period
Waiting period:

An amount of time (24 months) that those eligible for Social Security Disability Insurance must wait before enrolling in Medicare.