Understanding Insurance vocabulary

Co-insurance is a percentage. Your plan pays a set percent and you pay the remaining percent.

Co-pays are set amounts you pay for an appointment or a prescription. 

This is the amount you pay before the plan starts to pay.

Maximum out of pocket refers to Medicare Advantage plans and Individual health plans. This is the most you'll have to pay in a calendar year (January to December). If you meet this amount the plan pays all costs.

Amy refers to these plans as the "broom" that cleans up any bills after Original Medicare (Parts A and B) pays for a procedure or service. These are "Plans" (like G or N) that fill in the gaps where Original Medicare doesn't pay. 

 When choosing a plan, it's important to consider the provider network. Some plans have network restrictions, meaning you’ll need to use doctors, hospitals, and pharmacies that are part of the plan’s approved network. These can include HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) networks, each offering different levels of flexibility and cost. Knowing how your plan's network works can help you avoid unexpected costs and ensure access to the care you need. 

Original Medicare refers to Parts A and B, which became effective January 1, 1966.

Medicare Part A is a component of Original Medicare that helps cover inpatient hospital care, skilled nursing facility (SNF) care, hospice services, and limited home health care. It’s often referred to as hospital insurance.

While Part A covers many essential services, it comes with deductibles and potential out-of-pocket costs. That’s why many beneficiaries choose to enroll in a Medicare Supplement (Medigap) plan or a Medicare Advantage plan to help cover expenses that Part A doesn’t fully pay for.

 Medicare Part B is a key part of Original Medicare that helps cover outpatient medical services, including doctor visits, preventive care, ambulance services, durable medical equipment (DME), and certain prescription drugs administered by a physician.

Part B typically pays 80% of approved medical costs, leaving you responsible for the remaining 20%—with no annual out-of-pocket limit. Because of this, many people choose to add a Medicare Supplement plan (Medigap) or enroll in a Medicare Advantage plan to help reduce or eliminate those out-of-pocket expenses.

This is the amount you pay every month for your plan.

Click here to go the Contact Me page and send me a message. I'm happy to answer any of your questions.