Medicare Glossary
Understand key Medicare terms and concepts with our comprehensive glossary. Find definitions for common Medicare Advantage and healthcare terms.
Terms May Change
Medicare terminology and definitions can change over time. For the most current and official definitions, always refer to Medicare.gov or consult with licensed professionals.
Medicare Basics
Medicare Part A
Hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Medicare Part B
Medical insurance that covers outpatient care, preventive services, medical supplies, and some doctor's services.
Medicare Part C
Medicare Advantage plans offered by private companies that provide Part A and Part B benefits, often including additional coverage.
Medicare Part D
Prescription drug coverage that helps pay for outpatient prescription drugs. Can be included in Medicare Advantage plans or purchased separately.
Medicare Advantage Terms
HMO (Health Maintenance Organization)
A type of Medicare Advantage plan that typically requires you to use doctors, hospitals, and other providers within the plan's network.
PPO (Preferred Provider Organization)
A type of Medicare Advantage plan that allows you to see providers both in and out of the network, usually with lower costs for in-network providers.
IRMAA
Income-Related Monthly Adjustment Amount; adds to Part B/D premiums above certain MAGI thresholds.
AEP
Annual (Open) Enrollment Period, October 15 - December 7.
MA-OEP
Medicare Advantage Open Enrollment, January 1 - March 31.
Giveback / Part B Premium Reduction
A plan feature in some MA plans that reduces Part B premium.
PFFS (Private Fee-for-Service)
A type of Medicare Advantage plan that determines how much it will pay doctors, hospitals, and other providers and how much you must pay when you get care.
MAPD Plan
Medicare Advantage Prescription Drug plan that combines Part A, Part B, and Part D coverage into one plan.
Cost-Related Terms
Premium
The amount you pay monthly for your Medicare Advantage plan, in addition to your Part B premium.
Deductible
The amount you must pay for covered services before your plan starts to pay.
Copayment
A fixed amount you pay for a covered service, usually when you receive the service.
Coinsurance
The percentage of the cost of a covered service that you pay after you've paid your deductible.
Out-of-Pocket Maximum
The most you'll pay for covered services in a year. Once you reach this limit, your plan pays 100% of covered services.
IRMAA
Income-Related Monthly Adjustment Amount - an additional surcharge for Part B and Part D premiums if your income is above certain thresholds.
Network and Provider Terms
In-Network Provider
Doctors, hospitals, and other healthcare providers who have contracted with your Medicare Advantage plan to provide services at negotiated rates.
Out-of-Network Provider
Doctors, hospitals, and other healthcare providers who haven't contracted with your plan. You may pay more for their services.
Primary Care Physician (PCP)
A doctor who provides basic healthcare and coordinates your care with specialists. Some plans require you to choose a PCP.
Referral
A written order from your primary care doctor to see a specialist or get certain medical services.
Enrollment Terms
Initial Enrollment Period
The 7-month period when you can first enroll in Medicare, beginning 3 months before your 65th birthday and ending 3 months after.
Annual Enrollment Period
October 15 - December 7 each year when you can change your Medicare Advantage or Part D plan for the following year.
Special Enrollment Period
A time outside the regular enrollment periods when you can sign up for Medicare or change plans due to certain life events.
Guaranteed Issue Rights
Rights that protect you when you're in certain situations, allowing you to buy certain types of health insurance without medical underwriting.
Additional Benefits Terms
Part B Giveback
A benefit offered by some Medicare Advantage plans that reduces or eliminates your Part B premium.
Over-the-Counter Allowance
A benefit that provides a quarterly allowance to purchase over-the-counter health and wellness products.
Fitness Benefits
Gym memberships, fitness classes, or wellness programs included in some Medicare Advantage plans.
Transportation Benefits
Non-emergency transportation to medical appointments, available in some Medicare Advantage plans.
Need More Definitions?
This glossary covers the most common Medicare terms, but Medicare can be complex. For additional definitions and explanations, visit these resources:
Official Resources
- • Medicare.gov Glossary
- • CMS.gov Resources
- • 1-800-MEDICARE
Professional Help
- • Licensed insurance agents
- • Medicare counselors
- • SHIP programs
Important: This glossary provides general definitions of Medicare terms. Specific meanings and applications may vary by plan and location. For official definitions and current information, always refer to Medicare.gov or consult with licensed insurance professionals.