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Glossary of Medicare terms

Annual Enrollment Period (AEP): A set time each fall when you can make changes to your Medicare plan coverage. It runs from October 15 through December 7 each year.

Benefit period: The way Original Medicare measures your use of hospital and skilled nursing facility (SNF) services.

Brand-name drug: A prescription drug that is made and sold by the pharmaceutical company that researched and developed the drug.

Coinsurance: The percentage of the cost you pay for some covered health care services.

Copay or copayment: A set fee you pay when you visit your doctor or clinic or fill a prescription.

Covered drugs: The prescription drugs your health plan covers.

Covered services: The health care services and supplies your health plan covers.

The amount you pay for health care services before your plan begins to pay.

Extra Help: A Medicare program that helps people with limited income pay for prescription drugs, plan premiums and other health care costs.

Formulary: The list of generic and brand drugs that are covered by this plan.

Generic drug: A prescription drug that acts and works the same as a brand-name drug but often costs less.

Hospital inpatient stay: When your doctor formally admits you to the hospital for skilled medical care.

Initial Enrollment Period (IEP): If you are eligible for Medicare when you turn 65, this is the 7-month period when you can enroll. It includes the 3 months before the month you turn 65, the month you turn 65, and the 3 months after the month you turn 65.

Inpatient care: Services you receive when you are formally admitted to a hospital or skilled nursing facility.

List of covered drugs: This is the list of prescription drugs your health plan covers. It is often called a formulary.

Original Medicare: Both Part A hospital coverage and Part B medical coverage that you get from the federal government. Medicare Advantage plans from private health care companies include both your Part A and Part B coverage, plus extras like vision and dental benefits.

Out-of-pocket cost: Costs you pay for medical services or prescription drugs each year. Medicare Advantage plans place a limit, or maximum, on how much you could pay out of your own pocket each year for Medicare-covered services.

Outpatient care: Medical care you receive at a hospital, clinic or surgery center that does not require an overnight stay.

Plan network: The pharmacies, doctors, hospitals and clinics that are part of your plan, and where you can get care and fill prescriptions. In most cases, you will pay less for care and drugs when you stay in-network.

Premium: The amount you pay for your health plan or prescription drug coverage.

Preventive care: Routine health care that may include screenings and services to help prevent illness, disease or other health problems.

Primary care provider: The doctor you see first for health care. This doctor will also refer you to a specialist when you need one.

Prior authorization: Approval you may need to get from your health plan before you get some services or prescription drugs.

Skilled Nursing Facility (SNF) care: Care you receive in a nursing home or other facility on a continuous, daily basis. It can include physical therapy and drug injections you get from a nurse.

Specialist: A doctor that has advanced knowledge or training in a certain area of medicine.