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Medicare Details

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Medicare Part A

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Covers inpatient hospital care, skilled nursing facility care, hospice, lab tests, surgery, and home health care.

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Medicare Part B

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Covers outpatient care, doctor's services, preventive services, and medical supplies.

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Medicare Part C (Medicare Advantage)

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Alternative to Original Medicare (Parts A and B) provided by private insurance companies that includes all benefits and services covered under Part A and B, often with additional benefits.

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Medicare Part D

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Provides prescription drug coverage.

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Medigap (Medicare Supplement Insurance)

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Supplementary private health insurance sold to complement original Medicare coverage, helps pay some of the health care costs that Original Medicare doesn't cover.

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Medicare Premiums

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Monthly payments required for coverage under Medicare Part B and Medicare Part D, as well as for some Medicare Advantage and Medigap plans.

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Medicare Deductibles

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The amount you must pay out-of-pocket for health care services before Medicare begins to pay.

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Medicare Copayment

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A fixed amount (foreachmedicalservice)youllneedtopayasyourshareofthecostforamedicalserviceorsupply,likeadoctorsvisitorprescriptiondrug. for each medical service) you'll need to pay as your share of the cost for a medical service or supply, like a doctor's visit or prescription drug.

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Medicare Coinsurance

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The percentage of the cost of a covered health care service that you pay (20%, for example) after you've paid your deductible.

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Medicare Coverage Gap (Donut Hole)

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A temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap because their drug costs won't be high enough.

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Annual Notice of Change (ANOC)

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Document you receive from your Medicare Advantage or Part D plan detailing any changes in coverage, costs, or service area that will be effective in January.

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Medicare Special Needs Plans (SNPs)

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A type of Medicare Advantage Plan (like an HMO or PPO) that limits membership to people with specific diseases or characteristics and tailors their benefits, provider choices, and drug formularies to meet their specific needs.

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Medicare Eligibility

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Generally available for people age 65 or older, younger people with disabilities, and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

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Medicare Initial Enrollment Period (IEP)

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The 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

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Medicare General Enrollment Period

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If you miss your IEP, you can sign up during the General Enrollment Period between January 1st and March 31st each year, with coverage starting July 1st.

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Medicare Special Enrollment Period (SEP)

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A time outside the usual enrollment periods during which you can sign up for Medicare or make changes to your plan if certain events happen in your life, like moving or losing other insurance coverage.

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Medicare Preventive Services

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Includes a wide range of preventive services, such as screenings, vaccines, and annual wellness visits, at no cost if you have Medicare Part B.

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Medicare Advantage Open Enrollment Period

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From January 1st to March 31st each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare and join a separate Medicare drug plan.

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Medicare Assignment

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An agreement by your doctor, provider, or supplier to be paid directly by Medicare, accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

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Medicare Therapy Cap

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Limits on the amount Medicare will pay for outpatient physical therapy, speech-language pathology, and occupational therapy services in a calendar year.

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Medicare Coverage Outside the U.S.

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Generally, Medicare doesn't cover health care while you're traveling outside the U.S. Exception: In rare cases, Medicare may pay for inpatient hospital, doctor, ambulance services, or dialysis you get in a foreign country.

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Medicare Select

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A type of Medigap policy that requires you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.

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Medicare Quality Improvement Organizations (QIOs)

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Groups of health quality experts, clinicians, and consumers who improve the care delivered to people with Medicare.

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Medicare Late Enrollment Penalty

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A penalty that may be added to your monthly premium for Medicare Part B or D if you didn't sign up when you were first eligible and you don't have a qualifying reason for delaying.

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Medicare Savings Program

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A state program that provides help with paying Medicare premiums and, in some cases, may also pay Medicare Part A and Part B deductibles, coinsurance, and copayments if you meet certain conditions.

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