Learning the language of Medicare

January 18, 2021
aspire blog - 11 medicare key terms

Health literacy helps us prevent health problems, protect our health and better manage those problems and unexpected situations that might happen. Reading about Medicare can be like trying to understand a whole new language. However, understanding important Medicare and insurance key terms can boost your health literacy and help you make better decisions about your Medicare coverage.

11 Medicare key terms

  • Co-insurance – the percentage of costs of a covered healthcare service you pay (20 percent, for example) after you’ve paid your deductible.
  • Co-pay – a fixed cost you pay for certain services.
  • Coverage Gap – the period after you’ve reached your Initial Coverage Limit where you have a higher cost share for prescription drugs until you qualify for catastrophic coverage.
  • Deductible – the amount of money you pay before your insurance coverage takes over.
  • Formulary – a list of prescription drugs covered by your Medicare plan.
  • Initial Coverage Limit for prescriptions  Includes the total cost of drugs, including the deductible of what you and your plan pays, before entering the Coverage Gap
  • MOOP – maximum out-of-pocket amount you’ll spend annually for healthcare costs.
  • Out-of-pocket cost – the amount you pay for healthcare services, not counting a monthly premium.
  • Part B premium – the amount you pay every month for Original Medicare Part B coverage. It is usually deducted from your Social Security check.
  • Premium – a fee you pay each month for your Medicare plan. (separate from Part B)
  • Provider network – these are the doctors, hospitals, and specialists that will accept your Medicare plan. Generally, you pay less if you get care from providers in your plan’s network.

Of course, we’ve only scratched the surface on all things Medicare and Medicare education. Make sure that you check out other Aspire Health Plan blog posts in our All About Medicare category. And if you have any questions, do not hesitate to contact us at (855) 378-9680. (TTY users call 711.).

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