Reference

Medicare glossary

51 Medicare terms you'll encounter — in plain English, with Ohio context where it matters.

Jump to: A · B · C · D · E · F · G · H · I · L · M · N · O · P · Q · S · T

A

Annual Enrollment PeriodThe yearly window from October 15 through December 7 when Medicare beneficiaries can change Medicare Advantage plans, sw... Annual Notice of ChangeA document mailed to Medicare Advantage and Part D members every September detailing what will change about their plan f...

B

Benefit PeriodFor Medicare Part A: a unit of time that starts the day you're admitted as an inpatient and ends when you've been out of...

C

Centers for Medicare & Medicaid ServicesThe federal agency within the U.S. Department of Health and Human Services that administers Medicare, Medicaid, and the ... CoinsuranceYour share of the cost of a service, expressed as a percentage. For Original Medicare Part B, this is generally 20% of t... CopayA fixed dollar amount you pay for a specific service — e.g. $20 for a primary care visit. Common in Medicare Advantage a... Creditable CoverageOther health coverage you have that's considered at least as good as Medicare's. Lets you delay Medicare enrollment with...

D

DeductibleWhat you pay out of pocket before your insurance starts paying. In 2026: Part A is $1,736 per benefit period; Part B is ... Donut Hole (Coverage Gap)Historically, a phase of Part D drug coverage with higher cost-sharing. Eliminated as of 2025. The 2026 Part D out-of-po... Dual-Eligible Special Needs PlanA type of Medicare Advantage plan designed for people with both Medicare and Medicaid. Integrates the two coverage types...

E

Evidence of CoverageA detailed document from your Medicare Advantage or Part D plan explaining the full terms of coverage — what's covered, ... Extra Help (LIS)Federal program that helps pay Part D prescription drug costs for people with limited income and resources. Also called ...

F

FormularyThe list of prescription drugs a Part D or Medicare Advantage plan covers. Drugs are organized into tiers with different...

G

General Enrollment PeriodJanuary 1 – March 31 each year. For people who didn't enroll in Medicare when first eligible and don't have other credit... Guaranteed IssueA right to buy a Medigap policy regardless of your health history. You have guaranteed issue rights during your initial ...

H

Health Maintenance OrganizationA Medicare Advantage plan type that requires you to use the plan's provider network and usually requires a primary care ... Health Savings AccountA tax-advantaged savings account paired with a high-deductible health plan. You cannot contribute to an HSA in any month...

I

Income-Related Monthly Adjustment AmountExtra premium amount paid by higher-income Medicare beneficiaries for Parts B and D. Based on your tax return from 2 yea... Initial Coverage Election PeriodThe window during which you can first enroll in a Medicare Advantage plan after becoming eligible for Medicare. Usually ... Initial Enrollment PeriodThe 7-month window during which you first become eligible for Medicare — 3 months before your 65th birthday month, the b...

L

Late Enrollment PenaltyPermanent increase to your monthly premium for enrolling in Part B or Part D after your eligibility window without credi...

M

Maximum Out-of-PocketThe annual limit on what you'll pay in-network for covered services in a Medicare Advantage plan. Required by Medicare. ... Medicare AdvantagePart C of Medicare. A private alternative to Original Medicare that bundles Parts A, B, and usually D — plus extras like... Medicare Advantage Open Enrollment PeriodJanuary 1 – March 31. If you're already in a Medicare Advantage plan, you can switch to a different MA plan once or drop... Medicare Advantage Prescription Drug PlanA Medicare Advantage plan that includes prescription drug coverage. Most MA plans are MAPDs. Medicare Part AHospital insurance. Covers inpatient hospital, skilled nursing facility, hospice, and limited home health. Usually premi... Medicare Part BMedical insurance. Covers doctor visits, outpatient care, preventive services, and durable medical equipment. Standard 2... Medicare Part CMedicare Advantage. See 'MA' above. Medicare Part DPrescription drug coverage. Sold by private carriers; either standalone (with Original Medicare) or bundled into Medicar... Medicare Savings ProgramState-administered programs (QMB, SLMB, QI, QDWI) that help pay Medicare premiums and cost-sharing for people with limit... Medigap (Medicare Supplement)Private insurance that pays after Original Medicare pays, covering the deductibles, copays, and coinsurance Medicare lea... Modified Adjusted Gross IncomeAn IRS calculation used to determine IRMAA. Generally your AGI plus tax-exempt interest. Pulled from your tax return 2 y...

N

NetworkThe hospitals, doctors, pharmacies, and other providers that have contracted with a specific Medicare Advantage plan to ...

O

Ohio Senior Health Insurance Information ProgramOhio's State Health Insurance Information Program. Provides free, unbiased one-on-one Medicare counseling to Ohio reside... Original MedicareThe traditional federally-administered Medicare program consisting of Part A (hospital) and Part B (medical). Distinct f... Out-of-Pocket CostWhat you pay for healthcare services beyond what your insurance covers — deductibles, copays, coinsurance.

P

Preferred Provider OrganizationA Medicare Advantage plan type that lets you see both in-network and out-of-network providers (out-of-network typically ... PremiumThe monthly amount you pay for insurance coverage. You pay Part B premium to the government, Part D premium to your plan... Prescription Drug PlanA standalone Part D plan, used by people enrolled in Original Medicare. (As distinguished from MAPD plans, which bundle ... Primary Care ProviderYour main doctor — usually a family practice physician, internist, or geriatrician. Many Medicare Advantage HMO plans re... Prior AuthorizationA requirement that your plan approve a service before it's provided. Common in Medicare Advantage for specialist referra... Programs of All-Inclusive Care for the ElderlySpecialized programs that provide comprehensive medical and social services to certain frail, community-dwelling older a...

Q

Qualified Medicare BeneficiaryThe most comprehensive Medicare Savings Program. Pays Medicare Part A and B premiums, deductibles, and coinsurance for q...

S

Skilled Nursing FacilityA facility providing short-term medically-necessary skilled care after a hospital stay. Medicare covers up to 100 days p... Special Enrollment PeriodA window outside of normal enrollment periods when you can change Medicare coverage due to specific qualifying events — ... Star RatingA 1–5 quality score CMS assigns annually to Medicare Advantage and Part D plans based on member experience, clinical out... State Health Insurance Information ProgramFederally-funded, state-run Medicare counseling. In Ohio, this is OSHIIP. State Medical Identification (Submission ID)Internal identifier used by carriers for marketing material approval. Compliant Medicare marketing materials display the... SubluxationSpinal misalignment. Medicare covers chiropractic manipulation to correct subluxation but generally not other chiropract...

T

Third-Party Marketing OrganizationAny entity that markets Medicare plans on behalf of carriers without being the carrier itself — including FMOs, call cen... TRICARE for LifeHealth coverage for military retirees and their dependents. Requires Medicare Parts A and B enrollment and acts as secon...