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September 22, 2023

Gain a clear understanding of key terms related to Medicare Advantage insurance

If you're navigating the world of Medicare Advantage insurance, you may come across several terms that can be confusing or unfamiliar. To ensure you have a clear understanding of the coverage and benefits offered by Medicare Advantage plans, it's essential to familiarize yourself with these key terms. In this post, we'll explain some of the essential terms related to Medicare Advantage insurance. Let's dive in!

Understanding Medicare Advantage Insurance: Key Terms Explained

Knowing the key terms in Medicare is important to ensure a clear understanding of coverage, benefits, and navigating the complexities of the healthcare system.

Medicare Advantage

Medicare Advantage (also known as Medicare Part C) refers to a type of Medicare health plan offered by private insurance companies that provide an alternative to Original Medicare (Part A and Part B). These plans are required to provide at least the same coverage as Original Medicare, but often include additional benefits like prescription drug coverage, dental care, vision care, and wellness programs.

Medicare Assignment

Medicare Assignment refers to an agreement between healthcare providers and Medicare to accept the Medicare-approved amount as full payment for covered services. When a provider accepts Medicare Assignment, they agree to charge only the Medicare-approved amount for services, helping beneficiaries avoid additional costs or excess charges.


Coinsurance is the percentage of the cost of a healthcare service or treatment that you are responsible for paying after you have met your deductible. For example, if you have a 20% coinsurance, you would be responsible for paying 20% of the cost of the service, while Medicare would cover the remaining 80%.


A copayment (or copay) is a fixed amount that you pay out-of-pocket for a covered healthcare service. This is typically a set dollar amount, such as $20 for a doctor's visit or $10 for a prescription medication, that is paid at the time of service.

Creditable Prescription Drug Coverage

Creditable prescription drug coverage refers to prescription drug coverage that is comparable to or better than the standard Part D Medicare prescription drug coverage. Having creditable prescription drug coverage means that you can maintain your coverage without incurring penalties if you decide to enroll in a Medicare Part D plan in the future.

Medicare-Approved Amount

The Medicare-approved amount is the rate at which Medicare reimburses healthcare providers for covered services. This amount is determined based on the Medicare Fee Schedule and varies depending on the service and location. Providers who accept Medicare Assignment agree to accept the Medicare-approved amount as full payment.

Excess Charges

Excess charges are additional costs that may be charged by healthcare providers who do not accept Medicare Assignment. These charges can be up to 15% more than the Medicare-approved amount, and beneficiaries are responsible for paying them out-of-pocket.

In conclusion, understanding key terms related to Medicare Advantage insurance is crucial for navigating the complexities of these plans. By optimizing your content for relevant keywords and local search terms, you can improve your website's visibility and attract the right audience. Remember to provide valuable and informative content that addresses the needs of your readers, ensuring a positive user experience.

Call Lehigh Partners today at 833-265-9655 to enroll in a Medicare plan and ensure you have the right coverage for your healthcare needs. Don't wait, take care of your Medicare enrollment today!

Call Lehigh Partners at 833-265-9655 to enroll in a Medicare plan and get the right coverage for your needs today.

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