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14 Medicare terms to know

As you approach your 65th birthday and begin researching your Medicare options, you may quickly become overwhelmed by the sheer amount of information out there.

Then, once you start digging into the information, you may once again feel overwhelmed—this time due to the complex language.

If Medicare information feels like a foreign language to you, know that you’re not alone. According to the National Poll on Healthy Aging, 1-in-5 pre-Medicare adults ages 50 to 60 are only “slightly confident or not confident at all” when it comes to their ability to understand health insurance terminology.1

How can you make important decisions about your Medicare choices if you don’t understand what you’re reading?

Boost your Medicare knowledge!

To help boost your Medicare knowledge, we’re going to share a glossary of important Medicare terminology you need to know. Once you get a good grasp of these Medicare terms, you’ll be able to gain more confidence when it comes to making important decisions about your Medicare options.

Coinsurance:

is your share of the cost for covered services after meeting your deductible.

Copayment:

(also known as a copay) is a set amount you pay to the hospital, doctor or pharmacy at the time you use their service.

Deductible:

the amount you pay out of pocket before Medicare begins to pay health care costs.

Enrollment:

is when you’re eligible to start receiving Medicare, you can enroll in coverage. You can either be automatically enrolled or start the Medicare enrollment three months before you turn 65. Once enrolled in Medicare, you can change your Medicare health or prescription drug coverage for the following year during open enrollment, which occurs from October 15 to December 7. You can enroll in Medicare Supplement insurance at any time.

Foreign travel emergency:

is required care while traveling abroad. It is not covered by Medicare, is but offered as a benefit for certain Medicare Supplement insurance plans.

Long-term care:

is assistance provided to people who are unable to perform the activities of daily living on their own for an extended period. Medicare is not designed to cover long-term care. Paying for services out of pocket or purchasing a long-term care insurance plan are common ways of funding care costs.

Medicare Supplement:

is provided by private insurance companies, these benefits help fill coverage gaps left by Medicare.

Medicare Parts A-D:

Medicare coverage is separated into four parts. Medicare Part A is hospital coverage, Medicare Part B is medical coverage, Medicare Part C is Medicare Advantage Plans, and Medicare Part D is prescription drug coverage.

Medicare Part A:

is the hospital insurance portion of your plan that has benefits for inpatient hospital stays, inpatient skilled nursing facility care, home health services for part-time care, and hospice care.

Medicare Part B:

is the medical insurance portion of your plan that has benefits for doctors’ services, outpatient hospital services, medical services and supplies, home health services, and certain preventive care.

Medicare Part C ( Medicare Advantage Plans ):

is health plans provided by private companies offered as managed care plans. These health plans may have provider networks, may require specialist referrals, usually charge copays for services, and may offer additional coverage benefits.

Medicare Part D:

is prescription drug coverage that provides savings on the most widely used prescription drugs, covers both brand-name and generic medications, and is accepted by pharmacies. You must enroll to receive Part D benefits.

Medicare Supplement insurance plans:

These are standardized plans sold by private insurance companies to help you pay for out-of-pocket medical costs that Medicare may not cover. You must be enrolled in Medicare Part A and Medicare Part B in order to enroll in Medicare Supplement insurance. While Medicare Supplement plans feature the same benefits no matter who you buy them from, remember that not all insurance companies are created equal.

A B C D F, F1 G K L M N
Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance Hospitalization and preventative care paid at 100%; other basic benefits paid at 50% Hospitalization and preventative care paid at 100%; other basic benefits paid at 75% Basic including 100% Part B co-insurance Basic including 100% Part B co-insurance except up to $20 copayment for office visit and up to $50 copayment for ER
  Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance 50% Skilled Nursing Facility Coinsurance 75% Skilled Nursing Facility Coinsurance Skilled Nursing Facility Coinsurance 50% Skilled Nursing Facility Coinsurance
  Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible 50% Part A Deductible 75% Part A Deductible Part A Deductible Part A Deductible
  Part B Deductible Part B Deductible
  Part B Excess (100%) Part B Excess (100%)
  Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency
  Out-of-pocket limit $5240; paid at 100% after limit reached Out-of-pocket limit $2620; paid at 100% after limit reached

 

Premium:

is the monthly cost for health care coverage or insurance

Knowledge is power!

We hope our Medicare terminology glossary helps you gain more confidence when it comes to making important decisions about your Medicare coverage.

 

1University of Michigan, National Poll on Healthy Aging, https://www.healthyagingpoll.org/report/health-insurance-decision-making-near-retirement, January 3, 2019.

 

MEDICARE SUPPLEMENT INSURANCE POLICIES ARE UNDERWRITTEN BY COLONIAL PENN LIFE INSURANCE COMPANY WHICH ASSUMES SOLE FINANCIAL RESPONSIBILITIES FOR THOSE POLICIES.

COLONIAL PENN, BANKERS LIFE AND THEIR LICENSED AGENTS/PRODUCERS ARE NOT CONNECTED WITH OR ENDORSED BY THE U.S. GOVERNMENT OR THE FEDERAL MEDICARE PROGRAM.

THESE POLICIES HAVE LIMITATIONS AND EXCLUSIONS. FOR COSTS AND COMPLETE DETAILS OF COVERAGE, CONTACT AN INSURANCE AGENT/PRODUCER.

THESE PRODUCTS AND ITS FEATURES ARE SUBJECT TO STATE AVAILABILITY AND MAY VARY BY STATE.

MEDICARE SUPPLEMENT INSURANCE UNDERWRITTEN BY COLONIAL PENN LIFE INSURANCE COMPANY.

POLICY FORMS CPL-GR-A80A, CPL-GR-A80B, CPL-GR-A80C*, CPL-GR-A80F, CPL-GR-A80FH, CPL-GR-A80G, CPL-GR-A80K, CPL-GR-A80L, CPL-GR-A80M, CPL-GR-A80N

*Plan C is offered in: Arizona, Delaware, Georgia, Iowa, Illinois, Maryland, Nebraska, Nevada, New Jersey, Ohio and South Carolina
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COVERAGE IS LIMITED TO THE UNITED STATES ONLY, WITH THE EXCEPTION OF MEDICALLY NECESSARY EMERGENCY CARE IN A FOREIGN COUNTRY AVAILABLE UNDER PLANS C, F, FH, G, M, AND N.

COVERAGE IS LIMITED TO MEDICARE ELIGIBLE EXPENSES. BENEFITS PAID BY MEDICARE WILL NOT BE DUPLICATED.

MEDICARE SUPPLEMENT INSURANCE POLICIES SOLD IN THE STATE OF WISCONSIN DIFFER FROM THE ONES ADVERTISED ABOVE. IF YOU ARE A WISCONSIN RESIDENT, CONTACT YOUR LOCAL AGENT/PRODUCER FOR MORE INFORMATION.

ALL LINES OF BUSINESS IN NEW YORK ARE UNDERWRITTEN BY BANKERS CONSECO LIFE INSURANCE COMPANY. POLICY FORM PLANS ARE BLNY-GR-A80A(L4), BLNY-GR-A80B(L4), BLNY-GR­-A80F(14), BLNY-GR-A80FH(14), BLNY-GR-A80G(14), BLNY-GR-A80K(14), BLNY-GR-A80L(14), BLNY-GR-A80M(14), BLNY-GR-A80N(14).

AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST.

WHEN CHANGING INSURANCE CARRIERS, YOUR APPLICATION MAY BE UNDERWRITTEN AND YOU MAY BE RATED OR DENIED COVERAGE.

THIS POLICY MEETS THE MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT INSURANCE AS DEFINED BY THE NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES. THE EXPECTED BENEFIT RATIO FOR THIS POLICY IS 65.9 TO 68.3 PERCENT. THIS RATIO IS THE PORTION OF FUTURE PREMIUMS THAT THE COMPANY EXPECTS TO RETURN AS BENEFITS, WHEN AVERAGED OVER ALL PEOPLE WITH THIS POLICY.

MEDICARE SUPPLEMENT PRODUCTS ARE AVAILABLE IN MANY STATES TO INDIVIDUALS UNDER AGE 65 QUALIFYING AS DISABLED. ASK YOUR AGENT/PRODUCER ABOUT AVAILABILITY.

ADDITIONAL NEW YORK STATE RESIDENT INFORMATION
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