Definitions
Guaranteed renewable policy—An insurance
policy that can’t be terminated by the insurance
company unless you make untrue statements to
the insurance company, commit fraud, or don’t pay
your premiums. All Medigap policies issued since
1992 are guaranteed renewable.
Medicaid—A joint federal and state program that
helps with medical costs for some people with
limited income and resources. Medicaid programs
vary from state to state, but most health care costs
are covered if you qualify for both Medicare and
Medicaid.
Medical underwriting—e process that an
insurance company uses to decide, based on
your medical history, whether to take your
application for insurance, whether to add a
waiting period for pre‑existing conditions (if
your state law allows it), and how much to
charge you for that insurance.
Medicare Advantage Plan (Part C)—A type
of Medicare health plan oered by a private
company that contracts with Medicare. Medicare
Advantage Plans provide all of your Part A and
Part B benets, excluding hospice. Medicare
Advantage Plans include Health Maintenance
Organizations, Preferred Provider Organizations,
Private Fee‑for‑Service Plans, Special Needs
Plans, and Medicare Medical Savings Account
Plans. If you’re enrolled in a Medicare Advantage
Plan, most Medicare services are covered through
the plan and aren’t paid for by Original Medicare.
Most Medicare Advantage Plans oer prescription
drug coverage.
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're responsible for the dierence.
Medicare drug plan (Part D)
—Part D adds
prescription drug coverage to Original Medicare,
some Medicare Cost Plans, some Medicare
Private‑Fee‑for‑Service Plans, and Medicare
Medical Savings Account Plans. These plans are
offered by insurance companies and other private
companies approved by Medicare. Medicare
Advantage Plans may also offer prescription drug
coverage that follows the same rules as Medicare
drug plans.
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 benets.
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 rst month
that you’re covered under Part B and you’re 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.
Pre-existing condition—A health problem you
had before the date that new health coverage starts.
Premium—e periodic payment to Medicare, an
insurance company, or a health care plan for health
or prescription drug coverage.
State Health Insurance Assistance Program
(SHIP)—A state program that gets money from
the federal government to give free local health
insurance counseling to people with Medicare.
State Insurance Department—A state agency
that regulates insurance and can provide
information about Medigap policies and other
private health insurance.