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Medicare Terms to Know

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By Advisors Excel | Oct 15, 2020

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Benefit Period: Applies to Medicare Part A. Each benefit period begins on the first day services are provided and ends when you haven’t received benefits for 60 days in a row.

Claim: A request for payment by Medicare for medical services you receive. Claims can be made by you (the insured) or by the medical facility where the service is provided.

Coinsurance: The share of costs you pay after the deductible is met, usually designated as a percentage.

Copayment: The share of costs you pay for medical services, usually designated as a set amount.

Deductible: The amount you (the insured) must pay before an insurance company will pay a claim. This is in addition to monthly premiums paid for by you.

Formulary: List of prescription drugs that are covered by a prescription drug plan.

Initial Enrollment Period: Period of time when you can enroll in Medicare for the first time. This period begins three months before your 65th birthday and ends three months after the month when you turn 65.

Medicare Advantage Open Enrollment Period (MA OEP): During this time, Medicare Advantage enrollees can switch from their current Medicare Advantage plan to another Medicare Advantage plan or to original Medicare. Occurs each year from January 1 through March 31.

Medicare Annual Enrollment Period (AEP): Medicare enrollees can switch plans to reduce premium costs or add additional benefits. Occurs each year from October 15 through December 7.

Premium: The amount you pay each month for coverage. You may pay separate premiums for each part of Medicare.


Not sure where to start?

With all the options, we know that choosing the right Medicare plan for you can be a daunting task. If you’re not sure where to start, call Capper’s Insurance Service! (800-678-7741; Cappers Insurance)

We can help you navigate the different parts of Medicare and identify which benefits are important for you to receive.

Our experienced financial professionals have access to a wide variety of plans, and we will work with you to help determine which plans fit your health and budget. Whether you’re tackling initial enrollment or looking to lower your Medicare costs, we can help find the right plan to fit your needs. We’ll also walk you through the enrollment process from start to finish to ensure you don’t miss out on even one day of coverage.

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