Glossary
Medicare words, in plain English
Medicare has its own language. Here is what the words on your mail actually mean, with a link to the guide that goes deeper.
A
- Annual Enrollment Period (AEP)
- October 15 to December 7 each year. You can join, switch or drop a Medicare Advantage or Part D plan, and the change starts January 1. Learn more
- Annual Notice of Change (ANOC)
- The letter your Medicare Advantage or Part D plan sends by September 30 listing next year’s changes to premiums, copays, drug coverage and networks. Read it before Annual Enrollment. Learn more
- Assignment
- A doctor who "accepts assignment" agrees to take the Medicare-approved amount as full payment. They cannot charge you more than the usual deductible and coinsurance. Learn more
B
- Benefit period
- How Part A measures hospital and skilled nursing stays. It starts the day you are admitted and ends after 60 days in a row without inpatient care. The Part A deductible applies to each benefit period, not each year. Learn more
C
- Coinsurance
- Your share of a covered cost as a percentage. Under Part B you usually pay 20% of the Medicare-approved amount after the deductible. Learn more
- Copayment (copay)
- A set dollar amount you pay for a service or prescription, like $20 for a doctor visit. Common in Medicare Advantage and Part D plans.
- Creditable coverage
- Drug or health coverage that is at least as good as Medicare’s standard coverage. Having it lets you delay Part D (or Part B, for job-based health coverage) without a late penalty. Learn more
D
- D-SNP (Dual Eligible Special Needs Plan)
- A Medicare Advantage plan built for people with both Medicare and Medicaid. It coordinates the two programs and often includes extra benefits. Learn more
- Deductible
- What you pay before a plan starts paying. In 2026 the Part B deductible is $283 a year. The 2027 standard Part D deductible can be no more than $700. Learn more
- Dual eligible
- Someone who has both Medicare and Medicaid. Medicaid can help pay Medicare premiums and cost sharing, and dual eligibles can join a Dual Eligible Special Needs Plan. Learn more
E
- Excess charge
- Up to 15% more than the Medicare-approved amount that a doctor who does not accept assignment can bill you. Medigap Plan G covers it. Plan N does not. Learn more
- Extra Help (Low-Income Subsidy)
- A federal program that lowers Part D premiums, deductibles and copays for people with limited income and resources. You apply through Social Security. Learn more
F
- Formulary
- A drug plan’s list of covered prescriptions, sorted into tiers. Formularies change every year, which is why your drug list should be checked each fall. Learn more
G
- General Enrollment Period (GEP)
- January 1 to March 31, for people who missed their Initial Enrollment Period. Coverage starts the month after you sign up, and late penalties may apply. Learn more
- Guaranteed issue
- A right to buy a Medigap policy without health questions or higher prices for health reasons. You have it during your Medigap open enrollment and in certain situations after. Learn more
H
- High-deductible Plan G
- A version of Medigap Plan G with a yearly deductible ($3,050 in 2027) before the policy pays. Premiums are usually much lower than regular Plan G. Learn more
- HMO
- A Medicare Advantage plan type that generally requires you to use doctors and hospitals in its network, often with a primary care doctor coordinating your care. Learn more
I
- Initial Enrollment Period (IEP)
- Your first chance to sign up for Medicare: the 7 months around the month you turn 65 (3 before, your birthday month, 3 after). Learn more
- IRMAA
- The income-related monthly adjustment amount: an extra charge on Part B and Part D premiums for people with higher income, based on your tax return from two years earlier. Learn more
L
- Late enrollment penalty
- An extra amount added to your premium, often for life, if you sign up for Part B or Part D late without other qualifying coverage. Learn more
M
- Maximum out-of-pocket (MOOP)
- The most you pay in a year for covered medical services in a Medicare Advantage plan. Original Medicare has no such limit, which is why many people add a Medigap policy. Learn more
- Medicaid
- A joint federal and state program for people with limited income and resources. In Nebraska it is run by DHHS through Heritage Health plans. Different from Medicare. Learn more
- Medicare Advantage (Part C)
- A private plan approved by Medicare that replaces Original Medicare for your hospital and medical coverage, usually with drug coverage and extras included, and usually with a network. Learn more
- Medicare Advantage Open Enrollment Period
- January 1 to March 31. If you are in a Medicare Advantage plan, you can switch to another one or go back to Original Medicare once during this window. Learn more
- Medicare Prescription Payment Plan
- An option in every Part D and Medicare Advantage drug plan that spreads your out-of-pocket drug costs into monthly payments across the year instead of paying at the pharmacy counter. Learn more
- Medicare Savings Program (MSP)
- State programs (QMB, SLMB, QI) that help pay Part B premiums and sometimes deductibles and coinsurance for people with limited income. In Nebraska you apply through DHHS. Learn more
- Medicare Supplement (Medigap)
- A private policy that works alongside Original Medicare and pays some or all of what Medicare leaves you to pay. Plans are standardized by letter, so Plan G is the same coverage from every company. Learn more
- Medicare-approved amount
- The amount Medicare sets as the payment for a service. Your coinsurance is figured from it, not from the doctor’s list price.
- Medigap open enrollment
- A one-time 6-month window that starts the month you are 65 or older and enrolled in Part B. During it you can buy any Medigap plan without health questions. Learn more
N
- Network
- The doctors, hospitals and pharmacies a plan contracts with. Medicare Advantage networks change from year to year, so always check your providers for the coming year. Learn more
O
- Original Medicare
- Part A (hospital) and Part B (medical), run by the federal government. You can see any provider in the country that accepts Medicare. Learn more
- Out-of-pocket cap (Part D)
- The most you pay in a year for covered Part D drugs: $2,100 in 2026 and $2,400 in 2027. After you reach it, covered drugs cost $0 for the rest of the year. Learn more
P
- Part A
- Hospital insurance: inpatient stays, skilled nursing facility care after a qualifying stay, hospice and some home health. Most people pay no premium for it. Learn more
- Part B
- Medical insurance: doctor visits, outpatient care, lab work, preventive care and durable medical equipment. The standard premium is $202.90 a month in 2026. Learn more
- Part D
- Prescription drug coverage from private plans approved by Medicare. You get it through a standalone drug plan or a Medicare Advantage plan that includes drugs. Learn more
- Plan F
- The Medigap plan that covers everything Plan G does plus the Part B deductible. Only people eligible for Medicare before January 1, 2020 can buy it. Learn more
- Plan G
- The most complete Medigap plan people new to Medicare can buy. After the Part B deductible, it pays your share of Medicare-approved costs, including excess charges. Learn more
- Plan N
- A Medigap plan with lower premiums than Plan G in exchange for some copays (up to $20 at the doctor and up to $50 at the emergency room) and no excess charge coverage. Learn more
- PPO
- A Medicare Advantage plan type that lets you see out-of-network providers for a higher cost, with no referral needed for specialists. Learn more
S
- Scope of Appointment
- A short form that records which Medicare plan types you want to talk about before a sales appointment. It keeps the meeting to what you asked about.
- SHIP (Nebraska)
- Nebraska’s State Health Insurance Assistance Program, formerly called SHIIP: unbiased Medicare counseling run by the Nebraska Department of Insurance. It does not sell insurance. Learn more
- Special Enrollment Period (SEP)
- A window outside the usual dates to sign up or change plans after a life event, like losing job-based coverage or moving. Learn more
- Star Ratings
- Medicare’s 1 to 5 star quality scores for Medicare Advantage and Part D plans, updated every October on Medicare.gov. Learn more
T
- Tier
- The cost level a drug is placed on in a plan’s formulary. The same drug can sit on different tiers in different plans, which changes what you pay. Learn more
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