Important Terms

Annual Enrollment Period (AEP): From Oct. 15 – Dec. 7 people who are Medicare eligible can enroll in or disenroll from or change to the Medicare Advantage plan of their choice for the following year.

Coinsurance: A percentage of your medical and drug costs that you pay out of pocket.

Copayment: The fixed dollar amount you pay when you receive medical services or have a prescription filled.

Deductible: The amount you pay for medical services or prescriptions before your plan pays for benefits.

Formulary: Also called a drug list, the formulary lists the drugs your plan covers. It’s often divided into sections or tiers, based on the copayment for the covered drugs.

Health Maintenance Organization (HMO): Generally, a primary care physician arranges your healthcare in the plan’s network.

Initial Enrollment period (IEP): This is your first chance to sign up for Medicare. It starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after the month you turn 65.

Original Medicare: The traditional fee for service program offered directly by the federal government which pays for your healthcare. You can see any doctor who takes Medicare anywhere in the country.

Preferred Provider Organization: This type of health plan gives you the freedom to choose your own doctors and hospitals.

Premium: What you pay Medicare or a Medicare Plan for healthcare coverage.

Special Needs Plans: Plans that may offer benefits, providers and drug lists designed to meet the specific needs of the groups they serve. People with chronic conditions, like diabetes or heart conditions, or who are dually eligible for Medicare and Medicaid may benefit from this type of plan.