Having trouble understanding Medicare terms? Use our glossary of commonly used Medicare definitions and terms to get the answers you need.
Annual Enrollment Period
The period from October 15 to December 7 when you can enroll in a Medicare Advantage plan with Part D or a stand-alone Prescription Drug Plan, or switch Medicare plans.
appeal
A process to request your Medicare health plan to reconsider or perhaps change the decision of denying your request for coverage for the medical care coverage that you want.
Centers for Medicare & Medicaid Services (CMS)
The branch of the Department of Health and Human Services that administers Medicare.
catastrophic coverage
The part of the prescription drug benefit that kicks in after you have paid a certain amount in a calendar year.
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.
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.
end-stage renal disease (ESRD)
Permanent kidney failure that requires a transplant or dialysis.
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, visit the Medicare website† or call us anytime to learn more.
formulary
A plan’s list of covered prescription drugs.
grievance
Any expression of dissatisfaction (complaint) you make about us or one of our network providers or pharmacies, including a complaint concerning the quality of your care. This type of complaint does not involve coverage or payment disputes.
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).
low-income subsidy (LIS)
See Extra Help.
Medicaid
A joint federal and state program, separate from Medicare, that helps pay medical costs for people with low incomes, limited assets, and disabilities.
Medi-Cal
The official name of the Medicaid program in California.
Medicare
The federal health insurance program for people age 65 and older. It is also available to some people under 65 who have certain disabilities, and to people with end-stage renal disease.
Medicare Advantage
See Medicare Part C.
Medicare Advantage Disenrollment Period
The period from January 1 to February 14 when you can cancel your Medicare Advantage enrollment and switch to Original Medicare (Parts A and B only) or to a Medicare Cost plan with or without Part D coverage. If you switch to Original Medicare or a Cost plan without Part D, you also may choose a separate Medicare prescription drug plan (PDP) at the same time.
Medicare Cost plan
A plan offered through private health care companies that covers Part B services, and may include Part A services, as well as other benefits, such as the option of receiving prescription drug coverage (Medicare Part D). Cost plans allow you the option of receiving care from non-plan providers by paying Original Medicare deductibles and coinsurance.
Medicare Part A
Coverage that helps pay for hospital stays, skilled nursing care, some home health services, and hospice care.
Medicare Part B
Coverage that helps pay for physicians’ services, outpatient care, and other medical services not covered by Part A. Parts A and B together are known as Original Medicare.
Medicare Part C (Medicare Advantage)
A plan offered by a private organization as an alternative to Parts A and B only. Part C plans and Cost plans may offer more benefits than Original Medicare and may include Part D coverage.
Medicare Part D
Prescription drug coverage available as a stand-alone plan (PDP) or as part of a Medicare Advantage plan (MA-PD).
Medicare supplemental insurance
Plans sold by private companies to supplement Original Medicare coverage. Also known as Medigap plans, they are not to be confused with Medicare Advantage (Part C) or Cost plans.
Medigap
See Medicare supplemental insurance.
Original Medicare (also known as Traditional Medicare or fee-for-service Medicare)
Collective term for Medicare Parts A and B.
skilled nursing care
Treatment that must be given or supervised by a registered nurse (RN), such as intravenous injections or tube feedings.
Special Enrollment Period (SEP)
A time other than the annual election 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.
Special Needs Plan (SNP)
A Medicare Advantage plan for people who are institutionalized, or entitled to both Medicare and state Medicaid benefits, or have certain chronic conditions.
TTY
A teletypewriter (TTY) is a communication device used by people who are deaf, hard-of-hearing, or have a severe speech impairment.
†Kaiser Permanente is not responsible for the content or policies of external Internet sites.
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