Top 10 Medicare Terms to Know

Having trouble understanding Medicare terms? Medicare is the national health insurance program for seniors and some people with disabilities. The program can be complex and hard to understand. Use our glossary of commonly used Medicare definitions and terms to help you understand your Medicare coverage.     

  1. Annual Enrollment Period  – The period from October 15 to December 7 when you can enroll in a Medicare Advantage plan with Part D, a stand-alone Prescription Drug Plan, or switch Medicare plans.
  2. Appeal – A process to request your Medicare health plan to reconsider or perhaps change the decision of denying your request for coverage or payment.
  3. Coverage Gap – A stage in the Part D drug benefit during which you pay a certain percent of prescription drug costs set by Medicare. Also known as the “doughnut hole,” the gap begins after your costs reach an initial coverage limit and ends after you have paid enough to become eligible for catastrophic coverage. 
  4. Catastrophic Coverage – The part of the prescription drug benefit that kicks in after you have paid a certain amount in a calendar year. For 2020, that’s $6,350.
  5. Durable Medical Equipment (DME) – Certain medical equipment that is ordered by your doctor for use in your home. Some examples are walkers, wheelchairs, and hospital beds.
  6. Extra Help – Financial assistance from Medicare to help cover Part D drug plan costs. Also known as the low-income subsidy (LIS). To determine if you are eligible for Extra Help or other government assistance, click here.
  7. Formulary – A plan’s list of covered prescription drugs.
  8. Initial Enrollment Period (IEP) – The 7-month period when you first can enroll in Medicare (3 months before you turn 65, the month of your birthday, and the 3 months afterward).
  9. Medigap – Plans sold by private companies to supplement Original Medicare coverage by helping you cover some of the out-of-pocket costs of Medicare. Not to be confused with Medicare Advantage (Part C) or Cost plans.
  10. Special Enrollment Period (SEP) – A time other than the annual enrollment period or initial enrollment period when you may join, change, or drop a Medicare plan. An SEP can be triggered by certain events such as a change in residence.