Plain-language definitions
Glossary of insurance terms.
Insurance comes with a lot of jargon. Here are the terms seniors run into most, defined in everyday language.
- MOOP
- Maximum Out-of-Pocket. The most you'd pay in a year for covered medical services before your plan pays 100% for the rest of the year.
- Part B Giveback
- A benefit some Medicare Advantage plans offer that reduces your monthly Part B premium, putting money back in your pocket.
- Deductible
- The amount you pay for covered services before your plan begins to pay.
- Copay
- A fixed dollar amount you pay for a covered service, like $10 for a doctor visit.
- Coinsurance
- A percentage of the cost of a covered service that you pay, like 20% of a procedure.
- Formulary
- The list of prescription drugs a plan covers, organized into cost tiers.
- Premium
- The monthly amount you pay to have a health or insurance plan.
- HMO
- Health Maintenance Organization. A plan type that usually requires you to use in-network doctors and get referrals for specialists.
- PPO
- Preferred Provider Organization. A plan type that lets you see out-of-network providers, usually for a higher cost.
- D-SNP
- Dual-eligible Special Needs Plan. A Medicare Advantage plan designed for people who have both Medicare and Medicaid.
- MAPD
- Medicare Advantage with Prescription Drug coverage — bundles medical, hospital, and drug coverage in one plan.
- LIS / Extra Help
- A program that helps pay Medicare Part D prescription drug costs for people with limited income and resources.
- Network
- The doctors, hospitals, and pharmacies that have agreed to provide services to a plan's members.
- Prior Authorization
- When a plan requires approval before it will cover a certain drug or service.
- Referral
- Permission from your primary doctor to see a specialist, required by some plan types.
- Open Enrollment
- The time each year when you can change your Medicare Advantage or drug plan.