AEP (Annual Enrollment Period)
The yearly period from October 15 to December 7 when you can make changes to your Medicare coverage, including switching plans or joining/dropping Part D.
Assignment
An agreement by a doctor or supplier to accept the Medicare-approved amount as full payment for a covered service.
Benefit Period
The time frame used for measuring Part A benefits. It starts when you enter a hospital and ends when you have been out of inpatient care for 60 consecutive days.
Coinsurance
Your share of the cost for a covered service, calculated as a percentage. For Part B, it is typically 20% after you meet the deductible.
Copayment
A fixed dollar amount you pay for a covered service, such as $20 for a doctor visit under a Medicare Advantage plan.
Creditable Coverage
Health coverage that is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. Having creditable coverage prevents Part D late penalties.
D-SNP (Dual Eligible Special Needs Plan)
A type of Medicare Advantage plan designed for people who qualify for both Medicare and Medicaid (Medi-Cal in California).
Deductible
The amount you pay for covered services before Medicare begins paying its share. Part A and Part B have separate deductibles.
Donut Hole
The former coverage gap in Part D where beneficiaries paid more for prescriptions. The Inflation Reduction Act has effectively closed this gap with the $2,100 annual out-of-pocket cap.
Extra Help (LIS)
A federal program that helps people with limited income and resources pay for Part D prescription drug costs, including premiums, deductibles, and copays.
Formulary
A list of prescription drugs covered by a Part D plan or Medicare Advantage plan with drug coverage. Drugs are organized into tiers with different cost-sharing.
Guaranteed Issue Rights
Rights that protect you in certain situations by ensuring an insurance company must sell you a Medigap policy, must cover your pre-existing conditions, and cannot charge you more due to health problems.
HICAP
Health Insurance Counseling and Advocacy Program — California's SHIP program providing free, unbiased Medicare counseling in every county.
IRMAA
Income-Related Monthly Adjustment Amount — a surcharge added to Part B and Part D premiums for beneficiaries whose income exceeds certain thresholds.
Lifetime Reserve Days
Sixty additional hospital days that Medicare covers in your lifetime. Once used, they do not renew. The 2026 coinsurance is $868 per day.
Medi-Cal
California's Medicaid program providing health coverage to low-income residents. Some people qualify for both Medicare and Medi-Cal (dual eligible).
Medicare Advantage (Part C)
An alternative to Original Medicare offered by private insurers. Plans must cover everything Parts A and B cover and often include extra benefits.
Medicare Savings Program (MSP)
State programs (QMB, SLMB, QI) that help low-income Medicare beneficiaries pay premiums and cost-sharing.
Medigap
Medicare Supplement Insurance — private plans that help pay Original Medicare's out-of-pocket costs like deductibles and coinsurance.
Network
The doctors, hospitals, and suppliers that a Medicare Advantage or Part D plan has contracted with to provide healthcare services.
OEP (Open Enrollment Period)
The Medicare Advantage Open Enrollment Period from January 1 to March 31, when MA enrollees can switch plans or return to Original Medicare.
Original Medicare
The federal health insurance program consisting of Part A (hospital) and Part B (medical), administered directly by the government rather than private insurers.
Part A
Hospital insurance covering inpatient hospital stays, skilled nursing, hospice, and some home health services.
Part B
Medical insurance covering doctor visits, outpatient services, preventive care, and durable medical equipment. Standard premium is $202.90/month in 2026.
Part D
Prescription drug coverage offered through private plans. The 2026 annual out-of-pocket cap is $2,100.
SEP (Special Enrollment Period)
A time outside normal enrollment periods when you can sign up for or change Medicare coverage due to qualifying life events.
SHIP
State Health Insurance Assistance Program — the national program that provides free Medicare counseling. California's SHIP is called HICAP.
Star Rating
A 1-5 star quality rating system CMS uses to evaluate Medicare Advantage and Part D plans based on healthcare quality and customer service.