Annual Enrollment

This is the government set time of October 15th- December 7th when you can switch or sign up for an MAPD, MA, or Prescription plans. 

Annual Open Enrollment

This is the government ran period from January 1st- March 30th when you can disenroll from your MAPD and go back to original Medicare, which allows you to get a supplement and/or a drug plan.

Beneficiary 

The person who receives the payout of your policy. Typically refers to Life Insurance. 

Benefit Amount

Commonly used in life insurance, this is the amount paid to the beneficiary at the time of your passing.

 

Co-Insurance 

Is the percentage amount you are responsible for on an insurance bill.

Co-Pay

A set amount you pay per visit to a doctor, specialist, or ER.

Deductible

A set dollar amount you must meet before your insurance begins to pay.

Face Value

The amount of coverage on a life insurance policy.

 

Guaranteed for Life

As long as premiums are paid the Insurance Company can not drop you.

 

Guaranteed Issue

No health questions are asked, usually means more expensive premiums, and a waiting period.

Household Discount

A discount some companies offer. Insurance companies have different criteria to meet and qualify for this discount.

 

Indemnity

A sum of money paid out to you when certain claims are made on an insurance policy. 

 

Inpatient 

Anything that involves you being admitted to the hospital. 

 

Lump Sum 

A one time pay-out.

MA

This is the same as an MAPD just without the drug coverage.

MAPD

These are government ran plans that take the place of Original Medicare A and B. They have little to no monthly premium, have co-pays, deductibles, networks, and they do include drug coverage.

Medically Necessary

This is something that a doctor seems needs to be done so that you can have a normal life. If something is deemed medically necessary then Medicare will cover their part.

Medigap

Another name for a Medicare supplement, it is called this because it fills in the “gaps” Medicare doesn’t cover.

Network

A select group of Doctors, Specialist, and Hospitals that accept your plan.

Open Enrollment

Six months before or after you turn 65 or elect to take your Part B. During this time no company can ask health questions they must accept you no matter what and cannot drop you as long as premiums are paid. 

Outpatient 

Anything not involving admittance to the hospital. 

 

Part A

Covers your hospitalization care. You paid into Part A while working, and once you have worked 40 quarters you will receive Part A when you turn 65. Part A has a $1,364 deductible.

Part B

Covers your out-patient care. You elect when to take this once you turn 65. Part B has a monthly premium and covers 80% of your outpatient costs.

Part C

Technical name for the government ran Medicare Advantage Plans.

Part D

Government run prescription drug plans. You elect when you take Part B of Medicare. If you do not get a Part C that includes drug coverage or select a stand alone drug plan you will be penalized if/when you sign up. 

Premium

This is a payment made each month to a company for your insurance.

Prior Authorization 

When your doctor must obtain approval before the insurance will pay. 

 

Rated (Modified, Standard)

This means certain health questions could not be answered “no”. Coverage is still given but at a higher premium or with a waiting period.

Rider

An add-on to a policy for additional coverage in another area with an additional premium. 

Skilled Facility Care

These are facilities you may go to recover from surgery or other procedures such as: Nursing home, assisted living, and rehab center.

Specialist

Any doctor that specializes in one area but they are covered differently than your primary doctor

Step Therapy 

A cost reducing method with drug plans that starts with the most cost-effective drug being used and progresses to more costly drug until one is found that works. 

Waiting Period

A set amount of time that must pass before a policy will pay out or cover 100%.