Deductible, MOOP, formulary, IRMAA — the words that make insurance feel like a foreign language. Here's what they actually mean. Start typing to find a term.
The amount you pay for a plan each month, whether or not you use any care.
The amount you pay out of your own pocket for covered care before your plan starts paying its share.
A fixed dollar amount you pay for a covered service — for example, $20 for a doctor visit.
Your share of a cost as a percentage — for example, paying 20% of a bill while the plan pays 80%.
The most you'll pay for covered care in a year. After you hit it, the plan pays 100% of covered costs. "MOOP" stands for Maximum Out-Of-Pocket.
The doctors, hospitals, and pharmacies a plan contracts with. Staying in-network usually costs you far less.
A plan's list of covered prescription drugs, usually organized into tiers that affect what you pay.
Part A (hospital) and Part B (medical) provided directly by the federal government.
The hospital insurance part of Medicare — inpatient stays, skilled nursing, hospice.
The medical insurance part of Medicare — doctor visits, outpatient care, preventive services.
An all-in-one private plan that bundles Part A and B, usually with drug coverage and extra benefits.
Medicare's prescription drug coverage, available as a standalone plan or built into an Advantage plan.
A private policy that helps pay the out-of-pocket costs Original Medicare leaves behind.
Income-Related Monthly Adjustment Amount — an extra charge higher earners pay on Medicare Part B and D, based on income from two years prior.
The Low-Income Subsidy, a program that lowers prescription drug costs for people with limited income.
State programs (QMB, SLMB, QI) that help pay Medicare premiums and other costs for those who qualify.
Someone who qualifies for both Medicare and Medicaid, and may benefit from a coordinated D-SNP plan.
A Medicare Advantage plan tailored to a specific group — such as dual-eligible people (D-SNP) or those with certain chronic conditions (C-SNP).
Financial help that lowers Marketplace premiums based on your income and household size.
A set window each year when you can enroll in or change coverage. Medicare and the Marketplace each have their own.
A window opened by a qualifying life event — such as a move or a change in other coverage — letting you enroll outside the normal period.
The platform where individuals and families can shop for ACA health plans, often with subsidies.
A set of services every ACA Marketplace plan must cover, like doctor visits, hospital care, and prescriptions.
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