Medicare Dictionary

Trying to break down Medicare terminology? 

You’re in the right place. Check out common Medicare terms below:

1. Broker: A broker is licensed to represent and sell plans from multiple insurance providers to Medicare beneficiaries. RetireMed is a broker, though we consider ourselves advisors first and foremost.
2. Copay: A copay is a fee-for-service when you go to the doctor. Copays are a fixed dollar amount that you pay when you get a covered service.
3. Coinsurance: Coinsurance is similar to copay. You only pay coinsurance when you receive medical services covered by your plan. But instead of a fixed dollar amount, coinsurance is a fixed percentage of the total bill. 
4. Deductible: A deductible is an amount that you must pay out-of-pocket before your Medicare plan will cover costs. You pay a certain amount for a covered medical service and your insurance covers the remaining balance.
5. Extra Help: Extra help may be available to qualifying beneficiaries of both Medicare and Medicaid to offset the costs of monthly premiums, deductibles, and copays for prescription drugs. 
6. HSA (Health Savings Account): A health savings account - also known as an HSA  - is a type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. 
7. In-Network: In-network refers to physicians, hospitals, and other providers who accept your health insurance plan.
8. Insurance Provider: Insurance providers (also called insurance companies or insurance carriers) offer health care plans for purchase. Depending on the medical service, the carrier covers all or part of a given medical expense. Insurance providers offer both Medicare Advantage plans and Supplement (Medigap) plans.

9. Lifetime Reserve Days: A lifetime reserve day is any day past the 90-day mark that you are in inpatient care. Medicare Part A pays for 60 of these days throughout your lifetime.

10. Out-of-Network: Out-of-network means that a doctor, hospital, or other provider does not have a contract with your health insurance provider. Receiving services out-of-network can often result in paying more for the services.

11. Out-of-Pocket Maximum: Your out-of-pocket maximum is the most you will have to pay for covered medical expenses in a plan year. Once you have reached the limit on your out-of-pocket maximum through deductibles, copays and/or coinsurance, your plan will pay 100% of covered medical expenses for the remainder of the plan year.

12. Premium: Your plan’s premium is the monthly amount you will pay to the insurance company to keep your coverage active. Depending on the type of supplemental Medicare plan you choose, your plan’s premium could be as little as $0 a month.

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