Use it as you read our guides, your plan papers or a letter from Medicare. Terms are in alphabetical order.
Terms from A to C
Annual Enrollment Period: The window from October 15 to December 7 when you can change your Medicare Advantage or Part D plan. Changes start January 1.
Annual Notice of Change: A letter from your plan each fall that lists what will change the following year.
Assignment: A doctor's agreement to accept the amount Medicare allows as full payment.
Benefit period: The way Part A counts a hospital stay. It starts when you are admitted and ends after 60 days out of care.
Brand-name drug: A medicine sold under its maker's name, usually at a higher price than a generic.
Coinsurance: Your share of a bill, shown as a percent. For most Part B services, it is 20%.
COBRA: A law that lets you keep a former employer's health plan for a time, usually by paying the full cost.
Copayment: A fixed dollar amount you pay for a visit or a drug.
Cost-sharing: The general term for deductibles, copays and coinsurance.
Creditable coverage: Drug coverage that is at least as good as Medicare's standard drug coverage.
Custodial care: Help with daily tasks such as bathing, dressing and eating. Original Medicare does not pay for it long term.
Terms from D to G
Deductible: The amount you pay before your plan starts to pay.
Dual eligible: A person who has both Medicare and Medicaid.
D-SNP: A dual eligible special needs plan, which is a type of Medicare Advantage plan for people with both programs.
Durable medical equipment: Items such as walkers, wheelchairs and oxygen equipment that last over time and are used at home.
Evidence of Coverage: The plan's full rule book. It explains what is covered and what you pay.
Excess charge: The extra amount a doctor who does not accept assignment may charge above what Medicare allows, up to a limit.
Extra Help: A federal program that lowers Part D premiums and drug costs for people with limited income.
Formulary: A plan's list of covered drugs.
General Enrollment Period: The window from January 1 to March 31 when you can sign up if you missed your first window.
Generic drug: A medicine that works like a brand-name drug and usually costs less.
Guaranteed issue: A right to buy a policy, with no health questions, when the insurer must accept you.
Terms from H to L
Health Savings Account: A savings account for medical costs that you can no longer add to once you are on Medicare.
HMO: A Medicare Advantage plan type that usually asks you to use a network, and may ask for referrals.
Home health care: Skilled care you get at home, such as nursing or therapy, when a doctor orders it.
Hospice: Care that focuses on comfort for a person with a terminal illness.
Initial Enrollment Period: Your first seven-month window to sign up, around your 65th birthday.
Inpatient: A person formally admitted to a hospital. It is different from being held for observation.
IRMAA: The income-related monthly adjustment amount, which is the extra Part B and Part D premium that higher-income people pay.
Late enrollment penalty: An added cost for signing up late for Part B or Part D, when you did not have other coverage.
Lifetime reserve days: Sixty extra hospital days you can use once in your life, after day 90 of a benefit period.
Limiting charge: The most a doctor who does not accept assignment may charge, which is 15% above what Medicare allows.
Terms from M to O
Medicaid: A state and federal program for people with limited income or assets. In New Jersey, it is part of NJ FamilyCare.
Medicare Advantage: Also called Part C. It is a private plan that replaces Original Medicare.
Medicare Number: The number on your Medicare card. Keep it as private as your Social Security number.
Medicare Savings Program: A state program that may pay your Medicare premiums and some cost-sharing.
Medicare Summary Notice: A quarterly statement that lists the services billed to Original Medicare.
Medigap: Also called Medicare Supplement. Extra insurance that pays some costs that Original Medicare leaves.
Network: The doctors, hospitals and pharmacies that a plan has agreements with.
Open Enrollment Period (Medigap): A six-month window in which an insurer must sell you a Medigap plan, whatever your health.
Original Medicare: Parts A and B, run by the federal government.
Out-of-pocket maximum: The most you pay in a year for covered services. Medicare Advantage plans have one. Original Medicare does not.
Outpatient: Care that does not need an overnight hospital stay.
Terms from P to R
PAAD: New Jersey's Pharmaceutical Assistance to the Aged and Disabled program.
Part A: Hospital insurance.
Part B: Medical insurance for doctors and outpatient care.
Part C: Another name for Medicare Advantage.
Part D: Prescription drug coverage.
PDP: A prescription drug plan, which is a stand-alone Part D plan used with Original Medicare.
PPO: A Medicare Advantage plan type that allows out-of-network care, often at a higher cost.
Premium: The monthly amount you pay to have coverage.
Preventive services: Care that helps you stay well or find problems early, such as screenings and shots.
Primary care provider: The doctor you see first for most health needs.
Prior authorization: A plan's approval, required before it will pay for certain services or drugs.
Referral: A doctor's written recommendation that you see a specialist.
Terms from S to Z
Senior Gold: A New Jersey program that helps people with incomes above the PAAD limit pay for drugs.
Service area: The counties where a plan accepts members.
SHIP: The State Health Insurance Assistance Program, which offers free counseling about Medicare.
Skilled nursing facility: A place that gives short-term nursing or rehabilitation after a hospital stay.
Special Enrollment Period: A window outside the usual dates, which opens after certain life events such as a move.
Special needs plan: A Medicare Advantage plan built for people with certain conditions or situations.
Step therapy: A plan rule that asks you to try a lower-cost drug first.
Telehealth: Care from a provider by phone or video.
Tier: A level on a plan's drug list. Lower tiers usually cost less.
TTY: A device that lets people who are deaf or hard of hearing use a phone.
Quantity limit: A plan rule that caps how much of a drug you can get at once.
Where to learn more
Each term links to a longer idea on our guides. Start with the Medicare guide for Brick, NJ, then see new to Medicare or the coverage and costs hub. For help paying, visit the NJ help hub.
Still unsure what a word means?
Ask an insurance professional to explain it in everyday words. There is no such thing as a silly question about Medicare.
Frequently Asked Questions
What is the difference between a deductible and a copayment?
A deductible is what you pay before the plan pays. A copayment is a fixed amount you pay each time you get a service.
What is the difference between coinsurance and a copayment?
Coinsurance is a percent of the bill. A copayment is a set dollar amount.
Where can I get help understanding my plan?
Read your Evidence of Coverage, or call your plan, SHIP at 1-800-792-8820 or an insurance professional at (732) 641-1183.