Medicare terminology

Top 5 Medicare Terms You Should Know

Medicare terms can sometimes seem like an unknown language, but understanding some of the most common Medicare terms can help make it easy for you to navigate through your Medicare options and make an informed decision. We have defined the top 5 Medicare terms you should know as you prepare to choose a Medicare plan that fits your needs.

Benefit Period

This is the set amount of time during which Medicare will pay for Skilled Nursing Facility (SNF) and hospital services. The benefit periods start upon your admission to a hospital or skilled nursing facility. It ends once you have been discharged and didn’t receive any inpatient hospital care for at least 60 days.

In the situation where you are readmitted to a hospital or SNF within the 60-day period, you’ll be in the same benefit period. A new benefit period will start if you are admitted after those 60 days have passed, and you will be subject to the Medicare Part A copays and deductibles.

Cost-Sharing

This refers to the portion of medical services received that you are responsible for paying. Cost-sharing includes a combination of deductibles, copayments, or coinsurance. Medicare Supplement Plans K and L are good examples of cost-sharing plans. Plan K typically covers 50% of out-of-pocket costs, whereas Plan L covers 75%.

Donut Hole

This is also known as the Coverage Gap. This is one drug coverage stage a beneficiary may experience while they are a member of the Medicare Part D plan. This is the period during which there is a gap in the prescription drug coverage provided by Medicare Part D. And you’ll remain in this hole until your out-of-pocket spending meets the predetermined limits.

Formulary

The formulary is referred to as the list of medications that a Prescription Drug Plan covers. The formulary includes both generic and brand name drugs and contains at least two of the most commonly prescribed medications within each drug class.

Initial Enrollment Period

The Initial Enrollment Period (IEP) is the 7-month period you have to enroll in Medicare when you turn 65. The 7-month period starts three months before the month you turn 65 and lasts until three months after you turn 65.  

As you near retirement, you may wish to consult a Medicare professional to become familiar with the Medicare program. This is where we can help. If you have any questions about Medicare, contact iHealthcare Direct today, and we can help you find a plan that suits your needs.

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To learn more and get questions answered about your options, give us a call today at 713-900-1901. An experienced licensed agent will sit down with you and discuss your goals and needs to help find the perfect plan.