Here’s a helpful alphabetized list of definitions for common Medicare terms. If you’re new to Medicare, or just here to learn, you’ll probably come across these as you search for plans and manage your Medicare benefits.
Definitions of common Medicare terms
5-minute readPublished 03/28/2024Updated 01:03 PM EST, 01/08/2025
Annual Election Period (AEP)
Also called the
Annual Notice of Changes (ANOC)
This notice is sent each September by Medicare Advantage plans to their members notifying them of any changes in their coverage, costs or service in the coming plan year.
Coinsurance
Coinsurance is a percentage of your medical and drug costs that you may be required to pay as your share of costs for medical services or supplies (for example, 20% of the cost of a prescription drug).
Copayment
This is a specific dollar amount that you may be required to pay as your share of the cost for medical services or supplies (for example, a $10 copay for a doctor visit).
Creditable prescription drug coverage
This is coverage from another source (such as employer benefits) that is equal to or better than Medicare Part D prescription drug coverage.
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5-minute readPublished 03/28/2024Updated 01:03 PM EST, 01/08/2025
Deductible
The deductible is the amount you pay for medical services or prescription drugs in a plan year before your plan begins to pay for benefits.
Evidence of Coverage (EOC)
This document lists in detail your Medicare plan’s benefits and costs.
Drug List
Also called a
Health maintenance organization (HMO)
An
Initial Coverage Election Period (ICEP)
The
Medicaid
Jointly funded by federal and state dollars,
Medicare Advantage
See “Medicare Part C.”
Medicare Part A
Part of Original Medicare,
Medicare Part B
Part of Original Medicare,
Medicare Part C – Medicare Advantage
These plans are offered by private insurers approved by Medicare. By law,
Medicare Part D
- As Part D coverage combined with a Medicare Advantage (MA) plan
- As a stand-alone prescription drug plan (PDP)
Medicare Supplement insurance
Also called “Medigap” insurance,
Network
A network is a group of healthcare providers who have agreed to provide care based on a plan’s terms and conditions. These providers include doctors, hospitals and other healthcare professionals and facilities. With most plans, you’ll save money by using an in-network provider.
Medicare Advantage Open Enrollment Period (OEP)
This option is for people enrolled in Medicare Advantage only. The
Original Medicare
Also called Traditional Medicare, Original Medicare consists of Medicare Part A (hospital) and Part B (medical) coverage. It is offered directly by the federal government.
Out-of-pocket costs
These are any costs you are required to pay for medical care, prescriptions and other healthcare services, including coinsurance, copayments and deductibles. Medicare Advantage plans are required to set annual maximum out-of-pocket limits, after which you pay nothing for covered care.
Preferred provider organization (PPO)
A
Premium
The premium is the amount you are required to pay each month to Medicare or your private insurer for your healthcare coverage.
Provider
This is anyone who provides you with medical goods or services, such as a doctor, nurse, hospital or durable medical equipment provider.
Special Needs Plan (SNP)
These Medicare Advantage
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