- ACO
- Accountable Care Organization. Providers who agree to coordinate care for some people with Original Medicare. It is not a plan you enroll in, and it is not a Medicare Advantage network.
- AEP
- Annual Enrollment Period, October 15 through December 7, when you can generally change Medicare Advantage or Part D coverage for January 1.
- ANOC
- Annual Notice of Change. The letter a Medicare Advantage or Part D plan sends each fall about how costs, drugs, and benefits will change on January 1.
- Assignment
- A doctor who accepts the Medicare-approved amount as full payment.
- C-SNP
- Chronic Condition Special Needs Plan. A Medicare Advantage plan limited to people with certain chronic conditions. A diagnosis is not an approval.
- CMS
- Centers for Medicare & Medicaid Services. The federal agency that runs Medicare. This website is not CMS.
- Creditable coverage
- Drug coverage that is at least as good as Medicare’s standard Part D, on average.
- D-SNP
- Dual Special Needs Plan for people with Medicare and Medicaid. In California, Medicaid is Medi-Cal. Qualifying is decided by the plan and the state, not by this chat.
- DME
- Durable medical equipment, such as a walker or oxygen equipment, when Medicare’s rules say it is medically necessary.
- EOC
- Evidence of Coverage. The longer document that spells out a Medicare Advantage or Part D plan’s rules for the year.
- ESRD
- End-stage renal disease, which is permanent kidney failure. Enrollment rules can differ. Confirm on Medicare.gov.
- Formulary
- The list of drugs a Part D or Medicare Advantage plan covers, often grouped in cost tiers.
- GEP
- General Enrollment Period, January 1 through March 31, for people who missed signing up for Part A or Part B. It is not the fall Annual Enrollment Period.
- HICAP
- Health Insurance Counseling and Advocacy Program. California’s free Medicare counseling. Call 1-800-434-0222. HICAP is not an insurance agency.
- HMO
- Health Maintenance Organization. A Medicare Advantage plan type that usually requires the plan’s network and a primary doctor.
- I-SNP
- Institutional Special Needs Plan. A Medicare Advantage plan for people who live in a nursing home or need that level of care.
- ICEP
- Initial Coverage Election Period. The first window to join a Medicare Advantage plan when you are new to Medicare. The dates depend on when Part A and Part B start.
- IEP
- Initial Enrollment Period — generally the seven months around your 65th birthday.
- IPA
- Independent Practice Association. In California it is often the medical group that may handle referrals and prior approval on a Medicare Advantage HMO. The group is not the plan.
- IRMAA
- Income-Related Monthly Adjustment Amount — an extra amount higher-income people may pay for Part B and Part D.
- LEP
- Late enrollment penalty. An extra amount that may be added to Part B or Part D if you went without coverage when you were supposed to have it.
- LIS
- Low-Income Subsidy, also called Extra Help. A Social Security program that may lower Part D costs. This chat cannot say whether you qualify.
- MA
- Medicare Advantage, also called Part C. A private plan that delivers Medicare benefits. It is not the same as Original Medicare.
- MAPD
- A Medicare Advantage plan that includes Part D drug coverage. Also written MA-PD. Whether a plan includes drugs depends on that plan.
- MBI
- Medicare Beneficiary Identifier. The number on the Medicare card. Do not type it into this chat.
- Medigap
- Medicare Supplement insurance that helps pay certain Original Medicare cost-sharing amounts.
- MOOP
- Maximum out-of-pocket — the most you should pay in a year for covered in-network Part A and Part B services in a Medicare Advantage plan.
- MSN
- Medicare Summary Notice. The statement Original Medicare sends showing services billed to Part A or Part B.
- MSP
- Medicare Savings Program. A state program that may help pay some Medicare costs if you qualify. In California it runs through Medi-Cal.
- NEMT
- Non-emergency medical transportation. Some Medicare Advantage plans offer a set number of rides. Original Medicare generally does not.
- OEP
- Usually the Medicare Advantage Open Enrollment Period, January 1 through March 31, and only for people already in a Medicare Advantage plan. It is not the fall Annual Enrollment Period.
- OTC
- Over-the-counter. Some Medicare Advantage plans offer an allowance for certain drugstore items. It is not cash, and the rules vary by plan.
- PACE
- Program of All-Inclusive Care for the Elderly. For some people who need a nursing-home level of care and want to stay at home. This chat cannot say whether you qualify.
- PCP
- Primary care physician. In many Medicare Advantage HMOs, this doctor coordinates care and referrals.
- PDP
- Standalone Part D prescription drug plan.
- PFFS
- Private Fee-for-Service. A less common Medicare Advantage plan type. Confirm how a specific plan works on Medicare.gov.
- PPO
- Preferred Provider Organization. A Medicare Advantage plan type that usually has a network and may pay something for out-of-network care.
- QI
- Qualifying Individual. A Medicare Savings Program that may pay the Part B premium if you qualify and funding is available.
- QMB
- Qualified Medicare Beneficiary. A Medicare Savings Program that may pay Part A and Part B premiums and some cost sharing if you qualify.
- SEP
- Special Enrollment Period triggered by a qualifying event.
- SHIP
- State Health Insurance Assistance Program. Free Medicare counseling. In California the program is HICAP, 1-800-434-0222.
- SLMB
- Specified Low-Income Medicare Beneficiary. A Medicare Savings Program that may pay the Part B premium if you qualify.
- SNF
- Skilled nursing facility. A short-term stay for skilled care, not long-term custodial care. Original Medicare has a 3-day inpatient hospital rule for many stays.
- SNP
- Special Needs Plan. A Medicare Advantage plan limited to a group, such as certain chronic conditions, an institution, or people with both Medicare and Medicaid.
- SOA
- Scope of Appointment — required documentation before a Medicare Advantage or Part D sales appointment covering specific products.
- SSBCI
- Special Supplemental Benefits for the Chronically Ill. Optional extras some Medicare Advantage plans may offer to members with a serious chronic illness. A diagnosis is not an approval.
- TTY
- A text telephone. Medicare’s TTY line is 711.
Medicare Glossary
Plain-English definitions for the terms you will see on this site and in plan materials.