New Medicare Beneficiary? Here Are 4 Terms You Need To Know

New Medicare Beneficiary? Here Are 4 Terms You Need To Know

If you’ve recently enrolled in Medicare or if you’ve recently changed to a Medicare Advantage plan, you might be asking yourself how to understand the basics of Medicare terminology without buying a Medicare for Dummies –which is not such a bad idea after all.

Understanding your new Medicare policy will help you get the most out of your primary benefits while also preventing you from missing key aspects that might put your finances at risk.

Here are 5 key terms every Medicare beneficiary should know:


Traditional Medicare Vs. Medicare Advantage


When you enroll in Medicare you can either have Traditional Medicare (Part A and Part B) or a Medicare Advantage plan (Part C)

A Medicare advantage plan will provide you with the same benefits as your Traditional Medicare while also giving you extra benefits such as dental and vision coverage or even a gym membership.


Medicare Approved Charge


Medicare will only approve a certain amount of money for certain medical services. So let’s say your physician is charging you $400 for certain medical procedure but your Medicare approved charge is $200, in that case you would have to pay 20% of that lower charge ($40) with Medicare paying for the rest.


Copay, Coinsurance, Deductible


Your deductible is the top of what you have to pay for the whole year before your coverage starts paying for you. Your copayments are fixed payments you owe every time you pay for a service or prescription drug.


Approved list of drugs (Formularies)


When you enroll in Medicare you will receive a formulary, which is a list of drugs covered by your Medicare plan. This is why you should always check the formulary before choosing a particular Part D plan or Medicare Advantage plan to make sure all of your medications are included.


Can I change/update my current Medicare Plan?


Right now the Medicare Open Enrollment just ended. If you are a Medicare beneficiary and you expected to change to a Medicare Advantage plan or make any modification to your Medicare policy you’ll have to wait until the next year.

You can however qualify for a Special Enrollment Period that will allow you to enroll in a Medicare Advantage plan outside of the enrollment period.

The Medicare General Enrollment will begin in January, so if you have delayed your Part A and/or Part B enrollment you have the chance to enroll –even though you’ll have to pay a fee.


Need extra help? Call us!


If you need help with your quotes or you want to know more about Medicare terms and specialized guidance you can call us at: 305.676.7083

Belkys Galvez

At an early age Belkys found an interest in sports and nutrition, inspiring her to open a small business under the concept of a “nutrition bar”. Her establishment offered a ZEN ambiance where people mingled over healthy meals instead of alcohol. She also provided an all ladies boot camp class and provided weight loss programs for her clients. In 2013 she joined ACAP during the first “Obamacare” enrollment period. She was in charge of pre-qualifying all incoming calls soon thereafter managing customer service and now as Director of Operations leading the team in client focused efficiencies. Her passion continues to be natural wellness and the positive effects it has on physical and mental health. Follow her weekly nutrition & exercise posts!

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