Glossary of Medicare terms
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.
Deductible: 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. Your Medicare Supplement initial enrollment period begins when you enroll in Medicare Part B and lasts six months. During this time, you have guaranteed enrollment — meaning you can't be turned down and a health screening isn't required. Your coverage will renew automatically with no change to your benefits as long as you continue to pay your premium.
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.
Medicare Advantage plans: Medicare Advantage plans are offered by private insurance companies and bundle Medicare Part A, Part B and often Part D coverage. These plans, also known as Medicare Part C, offer the convenience of having all your health care benefits under one plan and typically include extra coverage for vision, dental, over-the-counter items, hearing aids and fitness.
Medicare Supplement plans: Medicare Supplement plans are purchased from private insurance companies and work alongside Medicare Part A and Part B to help fill gaps in out-of-pocket costs not covered by Original Medicare, like deductibles, copays and coinsurance. Often called Medigap, these medical-only plans provide added protection from unpredictable health care costs, move with you as you travel and may offer extras to help you stay healthy.
Original Medicare: Includes both Medicare Part A hospital coverage and Medicare Part B medical coverage that you get from the federal government. UCare Medicare Supplement Plans protect you from costly out-of-pocket expenses on copays, coinsurance and deductibles that Original Medicare doesn't cover.
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.
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: A doctor who will see you see for undiagnosed health concerns as well as provide continuing care for various medical conditions.
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: Medicare Part A covers care in a skilled nursing facility under certain conditions following a 3-day inpatient stay in the hospital. Medicare Part A does not cover long term or custodial care in a nursing home.
Specialist: A doctor that has advanced knowledge or training in a certain area of medicine.