Medicare, translated
Medicare words, in plain English
23 words you’ll run into in the mail, on the phone, and at the doctor’s office. A sentence or two each, with the official page next to it so you can check me.
Free consultation. No obligation to enroll.
- Licensed agent · NC Life & Health
- One local person, not a call center
- Meet at home, nearby, or by phone
- Free consultation. No obligation.
The parts of Medicare
Four letters, two paths. Start here if the alphabet is the confusing part.
- Original MedicareAlso called basic Medicare, traditional Medicare
Part A and Part B together, run by the federal government. You can see any doctor or hospital in the country that takes Medicare. It has no yearly limit on what you pay, and it doesn’t include prescription coverage.
Source: Medicare.gov: compare Original Medicare and Medicare AdvantageOriginal Medicare or Medicare Advantage?
- Part AAlso called hospital insurance
Covers inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice, and some home health care. Most people pay no premium for it because they or a spouse paid Medicare taxes for at least 10 years. In 2026 the hospital deductible is $1,736 for each benefit period.
Source: CMS: 2026 Medicare Parts A & B Premiums and DeductiblesEvery 2026 Medicare cost
- Part BAlso called medical insurance
Covers doctor visits, outpatient care, preventive care, and medical equipment. In 2026 most people pay $202.90 a month. After a $283 yearly deductible, you usually pay 20% of the Medicare-approved amount.
Source: CMS: 2026 Medicare Parts A & B Premiums and DeductiblesEstimate your Part B premium
- Medicare AdvantageAlso called Part C
A plan from a private insurance company that Medicare approves. It replaces Original Medicare as the way you get your Part A and Part B benefits, and most plans include drug coverage. Plans have a yearly limit on what you pay for covered care, and most use a network of doctors and hospitals. You still pay your Part B premium.
Source: Medicare.gov: compare Original Medicare and Medicare AdvantageMedicare Advantage or a Medigap plan?
- Part DAlso called prescription drug coverage
Drug coverage from a private plan, either on its own or built into a Medicare Advantage plan. Each plan has its own list of covered drugs, called a formulary. In 2026 no plan can charge a deductible above $615, and what you pay out of pocket for covered drugs is capped at $2,100 for the year.
Source: CMS: Final CY 2026 Part D Redesign Program Instructions
- MedigapAlso called Medicare Supplement
A policy from a private company that helps pay the deductibles and coinsurance Original Medicare leaves to you. It only works with Original Medicare, not with a Medicare Advantage plan. The plans are named with letters, and a given letter covers the same benefits no matter which company sells it.
Source: Medicare.gov: Choosing a Medigap Policy (official guide, PDF)Are Medicare Supplement plans the same?
What you pay
The words on a bill, and what each one means for your wallet.
- Deductible
What you pay for covered care before your coverage starts paying its share. Part A, Part B, and most drug plans each have their own.
- Copay and coinsurance
Your share of a bill after the deductible. A copay is a set dollar amount, like a flat fee for an office visit. Coinsurance is a percentage, like the 20% you usually pay under Part B.
- Out-of-pocket limitAlso called maximum out-of-pocket
The most you would pay in a year for covered Part A and Part B services in a Medicare Advantage plan. Each plan sets its own, up to a ceiling Medicare allows. Original Medicare by itself has no yearly limit.
Source: Medicare.gov: compare Original Medicare and Medicare Advantage
- Benefit period
How Part A counts a hospital stay. It starts the day you’re admitted and ends once you’ve been out of the hospital or skilled nursing facility for 60 days in a row. The $1,736 deductible applies to each benefit period, so you can owe it more than once in a year.
Source: CMS: 2026 Medicare Parts A & B Premiums and Deductibles
- IRMAAAlso called income-related monthly adjustment amount
An extra amount added to your Part B and Part D premiums when your income is above a set level. It’s based on your tax return from two years back. For 2026, it starts above $109,000 for a single filer or $218,000 filing jointly, using your 2024 return.
Source: Social Security: Medicare premiums and higher incomesDoes income affect Medicare premiums?
- Late enrollment penalty
An amount added to your premium if you sign up late without other qualifying coverage. For Part B it’s 10% for each full 12 months you waited, for as long as you have Part B. For Part D it’s 1% of the national base premium ($38.99 in 2026) for each month you went without drug coverage.
Source: Medicare.gov: avoid late enrollment penaltiesWork out the Part B penalty
- Creditable drug coverage
Drug coverage, such as from a job, that’s expected to pay at least as much as Medicare’s standard drug coverage. If you keep it, the Part D penalty doesn’t build up. The penalty can start once you’ve gone 63 days or more without it.
When you can sign up or change
Medicare runs on windows. These are the ones with names.
- Initial Enrollment PeriodAlso called IEP
Your first chance to sign up. It lasts seven months: the three months before the month you turn 65, your birthday month, and the three months after.
Source: Medicare.gov: when does Medicare coverage start?Find your own dates
- Annual Enrollment PeriodAlso called open enrollment, AEP
October 15 to December 7, every year. You can switch between Original Medicare and Medicare Advantage, change Advantage plans, or change drug plans. Changes start January 1.
Source: Medicare.gov: joining a planReviewing your plan each fall
- Medicare Advantage Open Enrollment
January 1 to March 31. If you’re already in a Medicare Advantage plan, you can switch to a different one or go back to Original Medicare, one time.
- Special Enrollment PeriodAlso called SEP
A window to sign up or change plans outside the usual dates. A life change opens it, such as moving out of your plan’s area or losing coverage from a job.
Source: Medicare.gov: joining a planSpecial Enrollment Periods
- Medigap Open Enrollment Period
Six months that start when you’re 65 or older and enrolled in Part B. During it, a company can’t turn you down for a Medigap policy or charge you more because of your health. After it ends, you may have to answer health questions.
Words in your plan’s mail
What the letters and booklets are actually telling you.
- Network
The doctors, hospitals, and pharmacies a Medicare Advantage plan has contracts with. An HMO generally covers care only inside its network, except in an emergency. A PPO lets you go outside it, usually for a higher cost.
Source: Medicare.gov: compare Original Medicare and Medicare AdvantageHMO or PPO?
- Annual Notice of ChangeAlso called ANOC
The letter your Medicare Advantage or drug plan sends each fall. It lists what changes on January 1: the premium, copays, covered drugs, and the network.
Source: Medicare.gov: upcoming plan changesHow to read your ANOC
- Skilled nursing facility careAlso called SNF, rehab
Short-term skilled care after a qualifying hospital stay. Under Original Medicare in 2026, you pay nothing for days 1 to 20 and $217 a day for days 21 to 100. After day 100, Medicare stops paying. It doesn’t cover long-term care in a nursing home.
Source: Medicare.gov: skilled nursing facility careDoes Medicare cover nursing homes?
Christian BrinkleyNC Life & Health · Greensboro, NC
Still sounds like alphabet soup?
That’s normal. Call me with the letter or the word that’s tripping you up, and I’ll explain it for your situation. No cost, no obligation.
Free consultation in person or by phone. It’s me who answers. Calls and appointments 9am to 5pm, Monday through Saturday, Eastern time.