Glossary
Annual Enrollment Period (AEP)
October 15 through December 7 each year. During this time, you can make changes to your Medicare coverage, including switching between Traditional Medicare and Medicare Advantage or changing drug plans.
Co-Insurance
A percentage of the cost you pay for a service after your deductible is met. For example, you might pay 20 percent and Medicare pays 80 percent.
Co-Pay (Copayment)
A fixed amount you pay for a healthcare service, like $20 for a doctor’s visit.
Deductible
The amount you pay for healthcare services before Medicare or your plan starts to pay.
Delays and Denials
Refers to when care is slowed down or not approved, often due to the insurance company requiring extra steps like prior authorizations.
Denial
When your health plan refuses to pay for a service or medication. This can happen before or after you receive care.
Hidden Costs
Expenses not clearly shown in a plan, such as costs for out-of-network care or services denied by insurance.
Initial Enrollment Period (IEP)
A seven-month window starting three months before your 65th birthday, including your birth month, and ending three months after. This is your first chance to enroll in Medicare.
Medicaid (TennCare)
A federal-state program that helps with healthcare costs for people with limited income. In Tennessee, it's known as TennCare or TennCare CHOICES.
Medical Underwriting
A process insurance companies use to decide whether to offer you a Medigap policy and at what price, based on your health history. This only applies if you’re not in your initial Medigap enrollment period.
Medically Necessary
Services or supplies needed to diagnose or treat a condition and meet accepted medical standards.
Medicare Advantage (Part C)
A private health plan that bundles Medicare hospital (Part A), medical (Part B), and often drug (Part D) coverage. These plans may have provider limits and require prior approvals for care.
Medicare Advantage Open Enrollment Period (MA OEP)
January 1 through March 31 each year. People already in a Medicare Advantage plan can switch to another or go back to Traditional Medicare.
Medigap (Medicare Supplement Insurance)
Private insurance that helps cover costs not paid by Traditional Medicare, such as copays, coinsurance, and deductibles.
Out-of-Pocket Costs
The money you pay yourself for healthcare, including deductibles, copays, and coinsurance.
Part A
Covers hospital stays, skilled nursing facilities, hospice care, and some home healthcare. Usually free if you’ve worked and paid Medicare taxes for 10 years.
Part B
Covers doctor visits, outpatient care, lab work, and preventive services. Most people pay a monthly premium.
Part C
See Medicare Advantage.
Part D
Helps pay for prescription drugs. You can get Part D through a standalone plan or as part of a Medicare Advantage plan.
Premium
The monthly amount you pay for Medicare or a health insurance plan.
Prior Authorization
When your insurance plan requires you to get approval before receiving certain medical services or prescriptions.
Provider Network
A list of doctors, hospitals, and healthcare providers your plan works with. Using in-network providers usually costs less.
Some Definition
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Special Enrollment Period (SEP)
Times outside regular enrollment periods when you can sign up for or change Medicare plans due to life events like moving or losing coverage.
Supplemental Insurance / Supplemental Insurance Coverage
Extra insurance that helps pay for things Medicare doesn’t fully cover, such as deductibles and coinsurance. Medigap is one type.
Traditional Medicare (Original Medicare)
Health insurance from the federal government. Includes Part A and Part B, with optional Part D and Medigap coverage for added protection.