Learn the Language of Medicare in Five Minutes

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Medicare. Medigap. Medi-what? Making sense of Medicare is no easy task. With encyclopedia-thick plan information and confusing terms like coinsurance and deductible, it's no wonder that it's hard to understand. Sit back and relax. We're breaking down the most commonly used terms and definitions for you.

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Coinsurance

This is the amount you may have to pay for your share of services. Coinsurance is usually a percentage (for example, 20 percent).

Copayment (or copay)

This is the amount you may have to pay for your share of services. Copays are usually a set amount (for example, $10 for a prescription drug or $20 for a doctor visit).

Deductible

This is the amount some plans require you to pay for covered services before the plan starts to pay.

Donut hole

This refers to a gap in coverage, during which you may have to pay more for your prescription drugs.

Formulary

This is a list of prescription drugs that a plan covers.

Maximum out-of-pocket amount

This is the most you'll pay in a year for certain health services. See your Evidence of Coverage (EOC) for more information, including the maximum amount you'll pay.

Original Medicare

This is the federal health insurance program for people 65 and older and for younger people with certain conditions or disabilities.

Medigap or Medicare Supplement plan

The two are interchangeable. If you're on Original Medicare, you can buy additional coverage through private insurance companies like Aetna. A Medigap (also known as a Medicare Supplement) plan can help pay for costs like copayments, coinsurance, and deductibles.


Looking for more information?
Visit Health's Senior Health and Wellness Resource Center,
your destination for 2019 Medicare information.


Premium

This is the amount you pay your plan for coverage.

True out-of-pocket (TrOOP) cost

This is the amount you pay for covered Part D drugs that counts toward your drug plan's out-of-pocket threshold. Your yearly deductible, coinsurance or copayments, and what you pay in the coverage gap all count toward this out-of-pocket limit. The limit doesn't include the drug plan's premium.

Amy Capomaccio is a health care writer at Aetna with experience in senior wellness, Medicare, Medicaid, and commercial health care. When she's not practicing new mindfulness techniques, Amy is spending time outdoors and traveling. Amy hails from Wakefield, MA and has a degree in Advertising and Public Relations from the University of Tampa.