Medicare Glossary in Plain English

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: When a doctor accepts the Medicare-approved amount as full payment for a covered service.
Benefit period: For a Part A hospital stay, it starts the day you are admitted and ends after 60 days in a row with no inpatient hospital or skilled-nursing care.
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 Medicare treats as at least as good as Part D. If you have it, you can usually delay Part D without a late penalty. Delaying Part B is a different rule. It depends on group coverage from current work, not this label.
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 website.
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: Doctor groups and networks that help manage your care. Also called a medical group or an IPA. The group is not the insurance company, and it is not the Medicare 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 website 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.
MAGI: Modified adjusted gross income. For the extra Part B and Part D amount, Medicare usually looks at the tax return from two years earlier.
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 a form or the chat on this website.
Medigap: Medicare Supplement insurance (also called Medigap). It 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. Prescription drug costs are not part of it.
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 website 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: A special time to enroll or change coverage after certain life events. Also called a Special Enrollment Period.
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. A required form confirming which Medicare products you want to discuss. It is not an enrollment.
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.
Underwriting: Health questions a Medicare Supplement company may ask. The company can charge more or decline you. Some windows do not allow those questions.

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