12 Incredibly Useful Medicare Terms You Need to Know

No matter where you find yourself in the process, Medicare terminology can be difficult to understand.

To make sure you’re getting the Medicare coverage that’s best for you and your unique situation, there are some “insurance-y” words with which you need to have some familiarity.

Here are 12 of the most important Medicare terms you need to know.

1. Premium

The cost you’ll pay each month for your Medicare healthcare, prescription drug coverage or any other supplemental plans.

2. Deductible

The amount you’re required to pay out of pocket before your Medicare, prescription plan or other coverage pays.

3. Copay or Coinsurance

Every healthcare service – think doctor’s visits or prescriptions, for example – requires you to pay a certain amount.

4. Medicare Part A

This the original Medicare plan that can cover expenses related to a hospital stay or care in a nursing home facility. It also includes hospice and home health care. There’s no monthly premium associated with Part A coverage, but you’ll usually have to pay your deductible if you have a hospital stay.

5. Medicare Part B

Also a part of Original Medicare, Part B requires you to pay a premium and covers services such as doctor visits, lab work, x-rays and mental health.

6. Medicare Advantage

Also known as Medicare Part C, this coverage is offered by private insurance carriers and covers healthcare services such as dental, vision and hearing.

7. Medicare Part D

Part D covers your prescription drugs. You’ll have to pay a monthly premium, deductibles, and copays.

8. Medigap

Once you’re covered by Medicare Parts A and B, you can buy this type of plan to cover the cost of deductibles and coinsurance that you would be responsible for out of pocket.

9. Health Maintenance Organization (HMO)

An HMO is a Part C (Medicare Advantage) plan. It requires that you use certain providers that are in a defined network. Other than the case of an emergency, the use of an out-of-network provider may not be covered if you don’t get approval first.

10. Preferred Provider Organization (PPO)

With a PPO Medicare Advantage plan, you’ll get a better financial benefit for using hospitals and doctors that are part of a defined network. You’ll pay more for using healthcare services that are outside of the network.

11. Initial Enrollment Period

The seven-month period of time during which you’re eligible to enroll in Medicare.

It begins three months before the month you turn 65, goes through your birthday month and continues for three months after your 65th birthday.

12. Medicare Annual Election Period

Each year, Medicare beneficiaries are allowed to change their coverage or enroll for the first time during the period from October 15 to December 7.

The important discussions

Having a grasp of these Medicare terms will help you to discuss your own situation with an expert insurance agent.

You can go it on your own, but it may result in you not getting the coverage you need at a price you can afford.

Which terms are still confusing to you?

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