Medigap Terminology

Medigap Policy
Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage.

Medigap Open Enrollment Period
A one-time-only, 6-month period when Federal law allows you to buy any Medigap policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B and you’re age 65 or older. During this period, you can’t be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional open enrollment rights under state law.

High-Deductible Medigap Policy
A type of Medigap policy that has a high deductible but a lower premium. You must pay the deductible before the Medigap policy pays anything. The deductible amount can change each year.

Guaranteed Issue Rights (also called “Medigap Protections”)
Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, such as exclusions for pre-existing conditions, and can’t charge you more for a Medigap policy because of a past or present health problem.

Assignment
An agreement by your doctor or other supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

Deductible
The amount you must pay for health care or prescriptions, before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Excess Charge
If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.

Out-of-Pocket Costs
Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance.

Medicare SELECT
A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.

Creditable Coverage (Medigap)
Previous health insurance coverage that can be used to shorten a pre-existing condition waiting period under a Medigap policy.

Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods.

Medicare Terminology

Medicare
The Federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Medicare Part A (Hospital Insurance)
Coverage for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)
Coverage for certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare-approved Amount
In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you may be responsible for the difference.