Along with the amount of plans to consider, there are many terms to understand when it comes to Medicare. Here are some of the most common terms and phrases you’ll run into when researching and shopping for Medicare plans.
Annual Enrollment Period
The Medicare Annual Enrollment Period (AEP) runs from October 15 to December 7 each year and allows current Medicare recipients to change or enroll in Medicare Advantage coverage.
Coinsurance
Coinsurance is the percentage of the Medicare-approved cost of your healthcare services that you are expected to pay after you’ve paid your plan’s deductible.
Copayment
Your copayment is a set out-of-pocket amount you are required to pay for each medical service you receive.
Deductible
A deductible is the established out-of-pocket amount you have to pay before your insurance takes over payment.
Dual Eligibility
Dual eligibility is when an individual is eligible for both Medicare and Medicaid.
End-Stage Renal Disease
End-stage renal disease (ESRD) occurs when a person’s kidneys fail and require a kidney transplant or dialysis treatment. Individuals with ESRD are automatically eligible for Medicare enrollment.
Extra Help
Medicare Extra Help (also known as Low-Income Subsidy) is meant to help people with limited income pay for prescription drugs. Those with dual eligibility automatically qualify for Extra Help.
General Enrollment Period
The General Enrollment Period runs from January 1-March 31 each year and is an enrollment opportunity for individuals who didn’t sign up for Original Medicare when they were first eligible.
Initial Enrollment Period
The Initial Enrollment Period is the first time an eligible person can enroll in Medicare Part A and Part B. The period begins three months before a person’s 65th birthday and continues through the three months following the person’s 65th birthday.
Open Enrollment Period
The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 each year and allows Medicare Advantage participants to make a one-time plan change.
Special Enrollment Period
The Medicare Special Enrollment Period (SEP) takes place when certain events or life changes occur, giving the opportunity to make changes to existing Medicare Advantage and Medicare Prescription Drug coverage.
Medicaid
Medicaid is a state and federal medical assistance program for people with limited incomes and resources.
Medicare Advantage
Medicare Advantage plans are a popular alternative to Original Medicare offered by private insurance companies. Medicare Advantage plans are legally required to offer the same benefits as Original Medicare but often also include additional coverage such as vision, dental, prescription drugs and health wellness programs.
Medicare Savings Programs
Medicare Savings Programs (MSPs) are state-run programs intended to help qualifying individuals pay for Medicare.
Medicare Supplement
Medicare Supplement Insurance plans—also known as Medigap insurance—help cover gaps in coverage from Medicare Part A and Part B. Medigap helps to fill the gaps in basic benefits, such as deductibles, coinsurance and copayments.
Part A
Medicare Part A, hospital insurance, is a part of Original Medicare that helps cover inpatient hospital, skilled nursing home, home health and hospice care.
Part B
Medicare Part B, medical insurance, is a part of Original Medicare that helps cover routine doctor visits, specialists and preventative services.
Part C
Medicare Part C plans, also known as Medicare Advantage plans, are an alternative to Original Medicare offered by private health insurance companies. Medicare Advantage plans are legally required to offer at least the same benefits as Original Medicare but often also include additional coverage, such as routine vision or dental, prescription drugs or health and wellness programs.
Part D
Medicare Part D, also referred to as Prescription Drug plans, help cover the cost of prescription medications and can be purchased in addition to Medicare Part A, B or Medicare Supplement plans.
Qualifying Individual Program
The Qualifying Individual (QI) Program helps qualifying individuals pay for Medicare Part B premiums.
Qualified Medicare Beneficiary Program
The Qualified Medicare Beneficiary (QMB) Program helps qualified individuals meet the costs of Medicare premiums and deductibles by making monthly payments towards a recipients’ Medicare Part A and Medicare Part B.
Qualifying Disabled and Working Individuals Program
The Qualifying Disabled and Working Individuals (QDWI) Program is a state administered Medicaid program that helps pay for Medicare Part A premiums.
Silver Sneakers
SilverSneakers is a benefit provided by some Medicare Advantage plans that gives Medicare beneficiaries access to gyms and fitness classes.
Specified Low Income Medicare Beneficiary Program
The Specified Low Income Medicare Beneficiary (SLMB) Program helps cover the cost of Medicare Part B premiums.
Learn more about Medicare and your plan options with SelectQuote.
Medicare can seem complicated, but at SelectQuote, we make it simple. We can compare coverage and costs of plans available to you in just minutes to make sure you’re getting all the benefits you deserve at a price you can afford. The service is free and there’s never an obligation to enroll.
