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Glossary of terms


Annual enrollment period:
October 15 to December 7. Medicare’s annual election period when you can enroll in a plan or change the way you receive coverage.

Benefit period: Time period that begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you haven’t received any inpatient hospital or SNF care for 60 days in a row.

Catastrophic coverage: When the plan pays most of the cost of your drugs for the remainder of the calendar year.

Coinsurance: An amount you are required to pay as part of your share of the cost for services. For example, if you have Medicare Part B, and you see your doctor because you don’t feel well, you are responsible to pay for 20% of the cost for that doctor office visit.

Copayment: A set dollar amount that you must pay as your share of the cost for services or items covered by your plan.

Coverage gap ("donut hole"): When you pay most of the plan's negotiated price for your drugs. The plan pays a little.

Deductible: The amount you must pay for health care or prescriptions before a plan begins to pay.

Extra Help: A Medicare program that helps people with limited income to pay for their prescription drug costs and medications. Costs covered may include premiums, deductibles, copayments and/or coinsurance.

HMO: Health Maintenance Organization plans. These plans are offered by private health insurance companies and offer a specific network of providers from whom their patients can receive care. Members of these plans must choose a primary care provider (PCP) who will coordinate their care and provide referrals when needed.

HMO-POS: Health Maintenance Organization plan with a Point-of-Service option. These plans are offered by private health insurance companies and offer out-of-network coverage for certain services. Members of these plans must choose a PCP.

Premium: The costs you must pay to Medicare and/or a private health insurance plan that provides you coverage. This cost is a set dollar amount and is typically paid on a monthly basis.

PPO: Preferred Provider Organization plans. These plans are offered by private health insurance companies and allow members to receive care in- or out-of-network. Members of these plans generally do not have to choose a PCP.

SCO: Senior Care Option plans. These plans are voluntary coverage plans offered by private health insurance companies. These plans combine social support with health care coverage to those who are 65 and older and are eligible for Medicaid coverage. Members of these plans must choose a PCP.

SNP: Special Needs Plans. These are a special type of Medicare Advantage plan that is offered by private health insurance companies which provide more focused health care for specific groups of people, such as those who have both Medicare and Medicaid, who reside in a nursing home, or  who have certain chronic medical conditions. Members of most of these plans must choose a PCP.

Fallon Health is an HMO/HMO-POS plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Senior Plan and NaviCare depends on contract renewal.

NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.


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The information on this page was last updated on 3/27/2017