Terms, in plain English.

The Medicare Advantage and Part D open enrollment window, October 15 through December 7 each year. The change you make takes effect January 1.

This is the only window most beneficiaries can switch plans without a qualifying event. The non-Medicare ACA Marketplace has a separate window.

The person who receives the benefit. On a life-insurance policy, this is the person who gets the death benefit. On Medicare, 'beneficiary' is the standard term for the enrollee.

The federal agency inside HHS that runs Medicare and (with states) Medicaid. CMS sets premiums, regulates carriers, and publishes the formularies.

Your share of a covered cost expressed as a percentage. After your deductible, you pay this percentage and the plan pays the rest.

Original Medicare Part B coinsurance is 20%. That's why most people layer a Medigap policy on top, there is no out-of-pocket maximum on Original Medicare.

A fixed dollar amount you pay for a covered service.

Medicare Advantage plans typically use copays ("$0 primary care visit, $35 specialist"). Original Medicare uses coinsurance instead.

The amount you pay out of pocket before your insurance starts paying.

Medicare Part B 2026 annual deductible is $283. Part A inpatient hospital deductible is $1,736 per benefit period.

The Part D coverage gap. Largely closed by the Inflation Reduction Act, there is now an annual out-of-pocket cap on Part D ($2,000 in 2026).

Someone enrolled in both Medicare and Medicaid. Eligible for Special Needs Plans (D-SNPs) that coordinate the two programs.

A middleman between insurance carriers and independent agents. FMOs provide contracting, training, and lead support. Goodsurance is independent, we are not an FMO.

A second-chance enrollment window for Medicare Part A/B (January 1 to March 31). Coverage takes effect the month after you sign up. Used by people who missed their IEP and do not have a Special Enrollment situation.

The window when you can first enroll in a Medicare Advantage plan, generally the same 7-month window as your IEP.

The 7-month window around your 65th birthday: 3 months before, your birth month, and 3 months after. The window in which you can enroll in Part A and Part B without a late-enrollment penalty.

An income-tested surcharge on Medicare Part B and Part D premiums. Applies above $109,000 single / $218,000 joint (2026 thresholds).

Based on your IRS-reported income from two years prior. You can appeal via SSA Form SSA-44 if you had a life event that reduced your income.

A private policy that fills in cost-sharing gaps in Original Medicare. Standardized plan letters (G, N, etc.), every Plan G is the same benefits regardless of carrier; only the price and customer service differ.

The most you can pay out of pocket in a year before the plan covers 100%. Medicare Advantage has a MOOP (typically $5,000 to 9,350 in 2026 depending on the plan). Original Medicare alone does not.

A unique number assigned to every licensed insurance producer in the U.S. Listed on each Goodsurance agent's email signature.

January 1 to March 31 each year. If you're enrolled in a Medicare Advantage plan you can switch to a different MA plan or drop back to Original Medicare. One switch only.

The hospital-insurance part of Original Medicare. Inpatient stays, skilled nursing, hospice. Free for most beneficiaries who have 40 work-quarters of Medicare-taxed earnings.

The medical-insurance part of Original Medicare. Doctor visits, outpatient, preventive care, durable medical equipment. Standard monthly premium is $202.90 in 2026; higher if you're subject to IRMAA.

Private alternatives to Original Medicare. Plans bundle Parts A + B (usually D too), often add dental/vision, and replace Original Medicare cost-sharing with copays + a MOOP.

Prescription drug coverage. Sold as standalone PDPs or bundled into Medicare Advantage plans. The 2026 annual out-of-pocket cap is $2,000.

A qualifying-event window that lets you enroll outside the standard windows. Common triggers: moving, losing employer coverage, qualifying for Extra Help, gaining Medicaid eligibility.

A free state-funded counseling program for Medicare beneficiaries. Required to be mentioned in every TPMO disclaimer. In California, the equivalent is HICAP.

A Medicare Advantage plan limited to a specific population, Dual-eligible (D-SNP), Chronic (C-SNP), or Institutional (I-SNP).

CMS-defined regulatory category covering organizations that market Medicare Advantage and Part D, including Goodsurance. Drives the disclaimer text you see on every Medicare page.

The carrier's process of evaluating whether to issue you a policy and at what rate. Heavy in life insurance (full medical exam optional), light in Medicare Advantage (no underwriting at all during your IEP).