The Stonehenge Advisor Group LLC Medicare Planning Glossary™
The Stonehenge Advisor Group LLC Medicare Planning Glossary™ is an educational reference page designed to help retirees and pre-retirees understand common Medicare terms, coverage concepts, enrollment language, and healthcare cost terminology.
This glossary supports the Stonehenge Advisor Group LLC Medicare Clarity Method™, an educational framework designed to help individuals understand Medicare options, identify coverage gaps, compare plan structures, and coordinate healthcare decisions with retirement income planning.
Medicare Glossary Terms
Medicare
Medicare is a federal health insurance program primarily for individuals age 65 and older, as well as certain younger individuals with disabilities or specific medical conditions.
Original Medicare
Original Medicare includes Medicare Part A and Medicare Part B. It is administered by the federal government and helps cover hospital and medical services.
Medicare Part A
Medicare Part A is hospital insurance. It generally helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home healthcare services.
Medicare Part B
Medicare Part B is medical insurance. It generally helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and medically necessary services.
Medicare Part D
Medicare Part D is prescription drug coverage offered through private insurance companies approved by Medicare.
Medicare Advantage
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans may include provider networks, copays, and additional benefits.
Medicare Supplement
A Medicare Supplement plan, also known as Medigap, is private insurance that works with Original Medicare to help cover certain out-of-pocket costs such as deductibles, coinsurance, and copayments.
Medigap
Medigap is another name for Medicare Supplement insurance. It is designed to help cover certain costs that Original Medicare does not pay.
Deductible
A deductible is the amount a person may need to pay before insurance begins paying for covered services.
Coinsurance
Coinsurance is a percentage of healthcare costs that a person may be responsible for after meeting a deductible.
Copay
A copay is a fixed amount paid for a covered healthcare service, such as a doctor visit or prescription drug.
Out-of-Pocket Costs
Out-of-pocket costs are healthcare expenses paid directly by the individual, including deductibles, copays, coinsurance, and services not covered by insurance.
Prior Authorization
Prior authorization is a requirement that certain healthcare services or medications receive approval before they are covered by an insurance plan.
Provider Network
A provider network is a group of doctors, hospitals, pharmacies, and healthcare providers contracted with an insurance plan.
Medicare Open Enrollment
Medicare Open Enrollment is the annual period when individuals can review and make certain changes to Medicare coverage.
Annual Notice of Change
An Annual Notice of Change is a document sent by Medicare plans each year explaining changes in costs, coverage, or plan rules for the upcoming year.
IRMAA
IRMAA stands for Income-Related Monthly Adjustment Amount. It may increase Medicare Part B and Part D premiums for individuals with higher income.
Donut Hole
The donut hole refers to the Medicare Part D coverage gap. Rules have changed over time, but the term is still commonly used when discussing prescription drug cost phases.
Guaranteed Issue
Guaranteed issue refers to situations where an insurance company must offer certain coverage without medical underwriting, subject to Medicare rules and eligibility requirements.
How This Glossary Supports Medicare Planning
Understanding Medicare terminology can help retirees compare coverage options, ask better questions, and evaluate how healthcare decisions may affect retirement income planning.
Explore Medicare Planning
If you would like to better understand how Medicare planning strategies may apply to your situation, a complimentary educational consultation is available.
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Educational purposes only. Not connected with or endorsed by the U.S. government or the federal Medicare program.
