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Every term on this page gets a one-sentence translation into normal English, then a short note on why it matters to your wallet, with real 2026 numbers where they exist. No jargon defined with more jargon.
This page exists because the words are the barrier. People do not struggle to pick a health plan because they are bad at decisions. They struggle because the choices are written in a language nobody taught them. Once deductible, coinsurance, and out-of-pocket maximum mean something, the comparison usually gets simple.
Skim the group that matches your question, or search below. And if a term still is not clicking, that is not a you problem. Ask us and a real person will explain it.
No matching term. Try a shorter word, or ask us directly, we answer these all day.
The five numbers that decide what a plan really costs you. Read these together, never one at a time.
The monthly bill you pay just to keep the plan, whether you use it or not.
It is the most visible number, and the least complete one. For 2026, the standard Medicare Part B premium is $202.90 a month, and that is before any plan you add on top.
What you pay out of your own pocket before the plan starts paying its share.
For 2026, the Medicare Part B deductible is $283, the Part A hospital deductible is $1,736 per benefit period, and a Part D drug plan can charge a deductible up to $615.
A flat dollar amount you pay for a visit or prescription, like $20 at the doctor's office.
Copays are predictable, which makes them easy to budget. Compare the copays on the services you actually use, not the ones on the brochure cover.
A percentage split. After the deductible, you pay your share of the bill, the plan pays the rest.
Original Medicare's Part B coinsurance is 20 percent with no yearly cap. That uncapped 20 percent is the main reason people add a Medigap plan or choose Medicare Advantage.
The most you can be required to pay for covered, in-network care in a year before the plan pays 100 percent.
This is your real worst-case number. Judge a plan by this and the deductible together, not by the premium alone.
Insurance shorthand for Maximum Out-Of-Pocket, the same thing as the out-of-pocket maximum.
You will see MOOP all over Medicare Advantage paperwork. Original Medicare by itself has no MOOP at all, which surprises a lot of people.
The alphabet soup on the plan card, translated. The letters mostly describe which doctors you can see and how.
The list of doctors, hospitals, and pharmacies that agreed to your plan's negotiated prices.
Out-of-network care can cost far more, or not be covered at all. Confirm your own doctors are in-network before you enroll, every single year.
A plan that covers in-network care only, except emergencies, usually with a primary doctor coordinating referrals.
The trade is simple: typically lower premiums in exchange for less flexibility. Fine if your doctors are in the network, frustrating if they are not.
A plan that lets you see out-of-network doctors, you just pay more when you do.
That flexibility usually costs more in premium. Worth it for some people, wasted money for others who never leave the network.
A hybrid: no referrals needed, but no out-of-network coverage except emergencies.
EPOs are common on the ACA Marketplace. The name sounds flexible, the network rules are strict, so check the directory first.
A high-deductible health plan: lower premium, higher deductible, and the plan design that unlocks an HSA.
For 2026, a plan must have a deductible of at least $1,700 for self-only coverage, or $3,400 for a family, to qualify. Not every high-deductible plan is technically an HDHP.
A tax-advantaged savings account for medical costs that you can only fund while enrolled in an HSA-eligible HDHP.
For 2026, you may contribute up to $4,400 for self-only coverage or $8,750 for family coverage. The money is yours forever, and the timing rules around Medicare matter.
The plan's list of covered drugs, sorted into pricing tiers.
The same prescription can cost wildly different amounts on two plans, and formularies change every year. Check yours against your actual medication list at each renewal.
The plan's permission slip: approval it requires before it will cover certain care or drugs.
Common on Medicare Advantage plans and for specialty drugs. If you have an ongoing treatment, ask whether it needs prior authorization before you switch plans.
Private insurance that pays the gaps Original Medicare leaves behind, like that uncapped 20 percent coinsurance.
Also called Medicare Supplement. The plan letters are standardized, so Plan G is Plan G at every company, but the prices are not.
Where the government's rules meet your wallet: ACA subsidies, Medicare surcharges, and the terms behind both.
Advance Premium Tax Credit, the ACA subsidy paid to your insurer each month to lower your premium.
It is based on the income you estimate for the year. Estimate too low and you may owe some back at tax time, so keep your estimate honest and updated.
What income counts for subsidies? Do I have to pay subsidies back?
Cost-Sharing Reductions, extra ACA help that lowers your deductible and copays, not just your premium.
CSRs only apply if your income qualifies and you pick a Silver plan. People who qualify and buy Bronze anyway leave real money on the table.
Modified Adjusted Gross Income, the income number the government actually uses for subsidies and Medicare surcharges.
It is not the same as your salary or your taxable income. Getting MAGI right is the difference between the subsidy you expect and the one you get.
A doctor who accepts assignment agrees to take Medicare's approved amount as full payment.
Most doctors do. When one does not, you can be billed extra, which is where Part B excess charges come from, two entries down.
Income-Related Monthly Adjustment Amount, a surcharge added to Part B and Part D premiums at higher incomes.
For 2026, IRMAA starts above $109,000 of MAGI for a single filer, or $218,000 filing jointly, based on your 2024 tax return. That two-year lookback catches a lot of new retirees off guard.
The old Part D coverage gap where drug costs jumped mid-year. It no longer exists.
The donut hole is closed, replaced by a hard annual cap. For 2026, you will not pay more than $2,100 out of pocket for covered Part D prescriptions, period.
The extra amount, up to 15 percent above Medicare's approved rate, a doctor who does not accept assignment may bill you.
Medigap Plan G covers excess charges, Plan N does not. If your doctors all accept assignment, this may matter less than the premium difference.
Someone who qualifies for both Medicare and Medicaid at the same time.
Dual eligibles may qualify for special plans, called D-SNPs, and extra help with costs, depending on income and state. It is worth checking rather than assuming.
The rules about when you can buy coverage and whether your health history is allowed to count against you.
The insurer reviewing your health history to decide whether to cover you, and at what price.
ACA plans cannot underwrite you. Medigap usually can once your first open enrollment window passes, which is why the timing of a Medigap purchase matters so much.
A situation where the insurer must sell you the policy with no health questions asked.
Your Medigap Open Enrollment window, the six months after Part B starts, is the big one. Certain plan cancellations and moves create guaranteed-issue rights too, depending on your situation.
Coverage the government considers at least as good as Medicare's, which lets you delay Medicare without a penalty.
If your employer or drug coverage is creditable, you can usually wait. If it is not and you wait anyway, late penalties can follow you for life.
A life change, like getting married, moving, or losing coverage, that opens a window to enroll outside Open Enrollment.
For most qualifying life events you get 60 days to act. Miss the window and you generally wait for the next Open Enrollment, which for 2026 ACA coverage ran November 1 through January 15.
What counts as a qualifying life event? Qualifying event finder
The enrollment window a qualifying life event opens, called an SEP.
ACA SEPs generally run 60 days from the event. Medicare has its own separate set of SEPs with different clocks, so never assume the rules transfer.
Medicare Special Enrollment Periods Medicare enrollment finder
Because a policy is a legal contract, and contracts need precise, regulator-approved definitions. The problem is that the industry then uses those contract words in its marketing too, so ordinary shoppers are asked to compare products written in a language they were never taught. You should not need a translator to buy health coverage. Since you effectively do, that is the job we have taken on.
No. The premium is only one of the numbers that decide what a plan costs you. A $0 premium plan still has copays, coinsurance, a network, and an out-of-pocket maximum, and those can add up to more than a plan with a monthly premium. A lower premium does not automatically mean lower overall cost. Judge every plan by the whole picture: premium, deductible, copays, and the out-of-pocket maximum together.
The out-of-pocket maximum. Most people compare plans by premium, some get as far as the deductible, and very few look at the number that actually caps their worst year. Two plans can have identical premiums and radically different out-of-pocket maximums. If you only learn one term on this page, learn that one.
The plain-English translations are ours. The underlying rules and every dollar figure come from official published sources: CMS and Medicare.gov for Medicare amounts, HealthCare.gov for ACA rules, and the IRS for HSA limits. All figures on this page are stated for 2026 and reviewed by our licensed team; amounts reset each year, so always check the year before trusting a number you find elsewhere.
Kate has translated insurance into plain English for clients since 2007. If a term on this page shows up in your own paperwork and you're not sure what it means for you, that's a five-minute conversation, free.
Send us the plan document that is confusing you. One free conversation and we'll translate your actual options into a clear recommendation, built around your doctors, medications, and budget.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 90 products in your area. Please contact medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
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