Glossary of Terms

A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It consists of Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Hospital insurance that covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working.

Medical insurance that covers certain doctors' services, outpatient care, medical supplies, and preventive services. Part B requires a monthly premium that varies based on income.

Plans offered by private companies approved by Medicare that provide all Part A and Part B benefits, often with additional coverage like prescription drugs, dental, vision, and hearing. Most plans have networks of providers.

Prescription drug coverage offered by private insurance companies approved by Medicare. Part D plans help cover the cost of prescription medications and are available to everyone with Medicare.

Private insurance that helps pay for some of the healthcare costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. Medigap policies are standardized and work alongside Original Medicare.

The traditional fee-for-service program offered directly through the federal government, consisting of Part A and Part B. You can see any doctor or hospital that accepts Medicare.

A specific time period when you can sign up for or make changes to your Medicare coverage. There are several types of enrollment periods, each with specific rules and deadlines.

The annual period (October 15 - December 7) when you can join, switch, or drop a Medicare plan. Changes made during OEP take effect on January 1 of the following year.

The 7-month period that begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after you turn 65. This is typically the best time to enroll in Medicare.

A time outside regular enrollment periods when you can sign up for Medicare or change plans due to certain life events, such as moving, losing other coverage, or qualifying for extra help.

A 6-month period that starts the month you're 65 and enrolled in Medicare Part B. During this period, you have guaranteed issue rights to buy any Medigap policy without medical underwriting.

Rights that require insurance companies to sell you a Medigap policy, cover all pre-existing conditions, and not charge you more due to health problems. These rights apply during your Medigap Open Enrollment Period.

The process insurance companies use to evaluate your health status and determine whether to offer you coverage and at what price. Medigap policies sold outside your Open Enrollment Period may require medical underwriting.

A temporary limit on what your Medicare Part D plan will cover for prescription drugs. Once you and your plan have spent a certain amount on covered drugs, you enter the coverage gap and pay a higher percentage of costs until you reach catastrophic coverage.

Prescription drug coverage that is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. Having creditable coverage allows you to delay enrolling in Part D without penalty.

A penalty added to your Medicare Part B or Part D premium if you don't enroll when you're first eligible and don't have other creditable coverage. The penalty typically increases the longer you delay enrollment.

Healthcare and other benefits provided by the Department of Veterans Affairs to eligible veterans. VA benefits include comprehensive medical services, prescription drugs, mental health services, and specialized care for service-connected conditions.

A disability that was incurred or aggravated during active military service, as determined by the VA. Service-connected disabilities may qualify veterans for additional benefits and priority healthcare access.

The VA uses priority groups (1-8) to determine when you can enroll in VA healthcare and how much you'll pay. Priority Group 1 includes veterans with service-connected disabilities rated 50% or more.

A healthcare program for uniformed service members, retirees, and their families. TRICARE provides coverage for active duty and retired military personnel and their dependents.

The Civilian Health and Medical Program of the Department of Veterans Affairs, which provides healthcare coverage for eligible dependents and survivors of veterans.

The process of determining which insurance plan pays first when you have coverage from multiple sources. Medicare and VA benefits don't coordinate - each system pays for its own services independently.

The amount you must pay for healthcare services before your insurance begins to pay. Medicare Part A and Part B each have their own deductibles that reset annually.

A fixed amount you pay for a covered healthcare service, usually when you receive the service. Copays are common in Medicare Advantage plans and some VA services.

Your share of the costs of a covered healthcare service, calculated as a percentage of the allowed amount for the service. Original Medicare typically requires 20% coinsurance for Part B services.

A group of doctors, hospitals, and other healthcare providers that have agreed to provide services to plan members at negotiated rates. Medicare Advantage plans typically have networks, while Original Medicare does not.

The most you'll have to pay for covered services in a plan year. After you reach this limit, the plan pays 100% of covered services. Medicare Advantage plans have out-of-pocket maximums, while Original Medicare does not.