Medicare glossary for Oregon

Jump to a letter: A · B · C · D · E · G · H · I · L · M · O · P · Q · S · T

Each term below has its own page with more detail, Oregon notes and sources; the full list is at the end.

AEP (Annual Enrollment Period)

October 15 to December 7 each year, when you can join, switch or drop a Medicare Advantage or Part D plan; changes start January 1. Medicare.gov calls it the Open Enrollment Period. The AEP for 2027 coverage runs October 15 to December 7, 2026.

Annual Wellness Visit

A yearly Part B visit to create or update your personal prevention plan, available after your first 12 months of Part B. You pay nothing for the visit if your provider accepts assignment. It isn't a routine physical exam, which Original Medicare doesn't cover.

ANOC (Annual Notice of Change)

The notice your Medicare Advantage or Part D plan sends by September 30 listing what changes on January 1: premium, cost sharing, drug list and networks. If your plan is ending in your Oregon county, you get a non-renewal letter instead.

Benefit period

How Part A measures hospital and skilled nursing facility care. It starts the day you're admitted as an inpatient and ends after 60 days in a row with no inpatient or skilled nursing care. You pay the Part A deductible ($1,736 in 2026) for each benefit period.

C-SNP (Chronic Condition Special Needs Plan)

A Medicare Advantage plan only for people with certain severe or disabling chronic conditions, such as diabetes, chronic heart failure or chronic lung disease. It includes Part D drug coverage.

CCO (Coordinated Care Organization)

The local plan that delivers Oregon Health Plan (Medicaid) benefits, part of Oregon's coordinated care model since 2012. If you have Medicare and OHP, your CCO doesn't change; you don't have to get medical care through it, but you must use a CCO for OHP dental and mental health care.

CMS (Centers for Medicare & Medicaid Services)

The federal agency that runs Medicare, approves and oversees Medicare Advantage and Part D plans, and works with states such as Oregon on Medicaid. Social Security handles signing up for Medicare.

Coinsurance

Your share of a covered cost as a percentage or daily amount. Under Original Medicare you usually pay 20% of the Medicare-approved amount for Part B services after the deductible, with no yearly limit.

Coverage gap (donut hole)

A former Part D phase in which people paid more for drugs. It ended in 2025: Part D now has a deductible, initial coverage and catastrophic coverage, with a yearly out-of-pocket cap on covered drugs ($2,100 in 2026).

Creditable coverage

Drug coverage expected to pay at least as much as standard Part D, such as many employer plans, VA and TRICARE coverage. Keeping it lets you join Part D later without a late enrollment penalty. Part B is different: only group coverage from current work lets you delay it without a penalty.

D-SNP (Dual Eligible Special Needs Plan)

A Medicare Advantage plan only for people with both Medicare and Medicaid. In Oregon, OHA describes D-SNPs as plans that work closely with the Oregon Health Plan and says they are available in many areas. Your OHP benefits continue whichever Medicare option you choose.

Deductible

What you pay for covered care before Medicare or your plan starts paying. In 2026: Part A $1,736 per benefit period, Part B $283 a year, and Part D plans up to $615.

DME (Durable Medical Equipment)

Reusable equipment your doctor orders for home use, such as walkers, wheelchairs, hospital beds, oxygen equipment and CPAP machines. Part B covers it; use a Medicare-enrolled supplier.

Extra Help (Low-Income Subsidy)

A federal program that lowers Part D premiums, deductibles and copays for people with limited income and resources. People with OHP or a Medicare Savings Program get it automatically; others apply through Social Security.

GEP (General Enrollment Period)

January 1 to March 31 each year, to sign up for Part B (or premium Part A) if you missed your Initial Enrollment Period and have no special enrollment period. Coverage starts the month after you sign up; a late enrollment penalty may apply.

Guaranteed issue right

Your right in certain situations, such as losing employer coverage or your Medicare Advantage plan ending, to buy a Medigap policy without health questions, usually within 63 days. Oregon's rules are OAR 836-052-0142 and, for the yearly birthday rule, OAR 836-052-0143.

HMO (Health Maintenance Organization)

A Medicare Advantage plan with a provider network. You generally must use network providers except for emergencies, urgent care and out-of-area dialysis, and may need a referral to see a specialist.

Home health

Part-time skilled nursing, therapy and related services at home for people who are homebound, ordered by a doctor and given by a Medicare-certified agency. Medicare doesn't cover 24-hour or personal care alone; in Oregon, Medicaid in-home services or Oregon Project Independence may help.

Hospice

Comfort care for a person with a terminal illness and a life expectancy of six months or less, covered by Part A. Oregon's Death with Dignity Act is a separate option; federal law bars Medicare from paying for its medication.

IEP (Initial Enrollment Period)

Your first chance to sign up for Medicare: 7 months, from 3 months before the month you turn 65 to 3 months after it. Oregon PEBB retiree coverage ends the month before you become eligible for Medicare, so state retirees should sign up on time.

IRA (Inflation Reduction Act)

The 2022 law that capped insulin at $35 a month, made recommended adult vaccines $0 under Part D, ended the coverage gap with a yearly Part D out-of-pocket cap, and let Medicare negotiate prices for some drugs starting in 2026.

IRMAA (Income-Related Monthly Adjustment Amount)

An extra charge on Part B and Part D premiums for people with higher income. For 2026 it starts at $109,001 of income for a single filer, from your 2024 tax return. You can ask Social Security to use a newer year after a life-changing event with Form SSA-44.

LEP (Late Enrollment Penalty)

An amount added to your Part B or Part D premium, usually for as long as you have that coverage, if you signed up late without other qualifying coverage. People with Extra Help don't pay the Part D penalty.

Lifetime reserve days

Sixty extra hospital days Part A covers after day 90 of a benefit period. You can use each only once in your lifetime, at $868 a day in coinsurance in 2026.

MA OEP (Medicare Advantage Open Enrollment Period)

January 1 to March 31 each year. If you're in a Medicare Advantage plan, you can make one change: switch to another Medicare Advantage plan, or go back to Original Medicare and join a Part D plan. People new to Medicare Advantage get the same one change in their first 3 months.

MA-PD (Medicare Advantage Prescription Drug plan)

A Medicare Advantage plan that includes Part D drug coverage. If you join a Medicare Advantage plan without drug coverage, you generally can't add a separate Part D plan, except with certain private fee-for-service plans or medical savings account plans.

Medical underwriting

When a Medigap company reviews your health history to decide whether to sell you a policy and at what price. In Oregon you avoid it during your Medigap open enrollment period, a guaranteed issue window, or the yearly birthday rule window.

Medicare Advantage (Part C)

A Medicare-approved plan from a private company that covers Part A and Part B services, usually with Part D drug coverage, and caps your in-network costs ($9,250 at most in 2026). For 2027, CMS lists 61 plans open to all beneficiaries in Oregon, but none in Grant, Harney, Lake, Umatilla or Union counties.

Medigap (Medicare Supplement)

Private insurance, sold in standardized lettered plans, that helps pay costs Original Medicare leaves, such as deductibles and coinsurance. Oregon has a birthday rule: if you have a Medigap policy, you can switch to one with the same or lesser benefits without health questions from 30 days before to 30 days after your birthday (OAR 836-052-0143).

Medigap open enrollment

Six months starting the first month you have Part B and are 65 or older, when any company must sell you any Medigap policy it offers without health questions. Oregon gives the same six months to people under 65 who have Medicare because of a disability, at a premium no higher than the company charges at 65 (OAR 836-052-0138).

MSP (Medicare Savings Programs)

State programs that pay Medicare premiums, and for QMB also deductibles and coinsurance, for people with limited income: QMB, SLMB (Oregon calls it SMB), QI (SMF in Oregon) and QDWI. Oregon has no asset limit for them. Apply through the Oregon Department of Human Services at ONE.Oregon.gov or 1-800-699-9075.

Observation status

When you're in a hospital as an outpatient, even overnight, rather than admitted as an inpatient. Part B costs apply, and observation time doesn't count toward the 3-day inpatient stay Medicare requires before covering skilled nursing facility care. If you're under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice.

OHP (Oregon Health Plan)

Oregon's Medicaid program, run by the Oregon Health Authority. People with both Medicare and OHP are dual eligible; most have "OHP with Limited Drug," so Part D covers their prescriptions, and OHP can help pay Medicare premiums, deductibles and coinsurance. OHP Client Services: 1-800-273-0557.

Original Medicare

Part A (hospital insurance) and Part B (medical insurance), run by the federal government. You can use any doctor or hospital in the U.S. that accepts Medicare, there's no yearly out-of-pocket limit, and you can add a Part D drug plan and a Medigap policy.

Out-of-pocket maximum

The most you pay in a year for covered care. Original Medicare has none. In 2026, Medicare Advantage in-network limits can't exceed $9,250, Part D caps covered drug costs at $2,100, and Medigap Plans K and L have limits of $8,000 and $4,000.

PACE (Program of All-Inclusive Care for the Elderly)

A Medicare and Medicaid program for people 55 and older who need a nursing-home level of care but can live safely in the community with help. A PACE team provides medical and social care, often through a PACE center. In Oregon it's available only in some areas.

Part A

Hospital insurance: inpatient hospital care, skilled nursing facility care, hospice and some home health care. Most people pay no premium because they or a spouse worked about 10 years; others pay up to $565 a month in 2026. The deductible is $1,736 per benefit period.

Part B

Medical insurance: doctor visits, outpatient care, preventive services and medical equipment. In 2026 the standard premium is $202.90 a month and the deductible is $283; after that you usually pay 20% coinsurance.

Part D

Medicare prescription drug coverage from private plans, either a standalone drug plan or a Medicare Advantage plan with drugs. Out-of-pocket costs for covered drugs are capped at $2,100 in 2026. Oregon and Washington form Part D region 30.

PDP (Prescription Drug Plan)

A standalone Part D plan you add to Original Medicare, with or without Medigap. CMS lists 8 standalone Part D plans from 4 companies in Oregon for 2027.

PPO (Preferred Provider Organization)

A Medicare Advantage plan with a network that also covers out-of-network care, usually at a higher cost. You generally don't need referrals to see specialists.

Premium

The amount you pay each month for coverage, whether or not you use care. Most people pay no Part A premium; the standard Part B premium is $202.90 a month in 2026, and Part D, Medicare Advantage and Medigap plans set their own.

QMB (Qualified Medicare Beneficiary)

The Medicare Savings Program that pays Part A and Part B premiums, deductibles, coinsurance and copays. Providers may not bill a QMB member for Medicare cost sharing. In Oregon it covers income up to 100% of the federal poverty level, with no asset limit.

SEP (Special Enrollment Period)

A chance to change Medicare coverage outside the usual windows after certain events, such as losing job-based coverage, moving, or getting Medicaid. In Oregon, a disaster declared by a federal, state or local government, such as a wildfire, can trigger one, and members of plans ending for 2027 have an SEP through February 28, 2027.

SMP (Senior Medicare Patrol)

A federally funded program that helps people with Medicare prevent, detect and report health care fraud, errors and abuse. The national SMP Resource Center, 1-877-808-2468, connects you with your state's SMP; you can also report suspected Medicare fraud to 1-800-MEDICARE.

SNF (Skilled Nursing Facility)

A facility that provides daily skilled nursing or rehabilitation. After a qualifying 3-day inpatient hospital stay, Part A covers up to 100 days per benefit period: days 1 to 20 at no cost and days 21 to 100 at $217 a day in 2026. Medicare doesn't cover long-term custodial care.

SNP (Special Needs Plan)

A Medicare Advantage plan limited to people with both Medicare and Medicaid (D-SNP), certain chronic conditions (C-SNP), or who live in an institution or need that level of care at home (I-SNP). CMS lists 26 special needs plans in Oregon for 2027.

Star Ratings

CMS's quality ratings for Medicare Advantage and Part D plans, on a scale of 1 to 5 stars, updated each fall and shown on Medicare.gov's plan finder. This site doesn't rate or rank plans.

TPMO (Third-Party Marketing Organization)

A company or person, such as an insurance agency or a licensed insurance agent, that sells or markets Medicare Advantage or Part D plans for the companies that offer them. TPMOs must follow CMS marketing rules and give CMS's standard disclaimer. Benefits Life, this site's publisher, is a TPMO.

All glossary term pages

• AEP (Annual Enrollment Period)
• Annual Wellness Visit
• ANOC (Annual Notice of Change)
• Benefit period
• C-SNP (Chronic Condition Special Needs Plan)
• CCO (Coordinated Care Organization)
• CMS (Centers for Medicare & Medicaid Services)
• Coinsurance
• Coverage gap (donut hole)
• Creditable coverage
• D-SNP (Dual Eligible Special Needs Plan)
• Deductible
• DME (Durable Medical Equipment)
• Extra Help (Low-Income Subsidy)
• GEP (General Enrollment Period)
• Guaranteed issue right
• HMO (Health Maintenance Organization)
• Home health
• Hospice
• IEP (Initial Enrollment Period)
• IRA (Inflation Reduction Act)
• IRMAA (Income-Related Monthly Adjustment Amount)
• LEP (Late Enrollment Penalty)
• Lifetime reserve days
• MA OEP (Medicare Advantage Open Enrollment Period)
• MA-PD (Medicare Advantage Prescription Drug plan)
• Medical underwriting
• Medicare Advantage (Part C)
• Medigap (Medicare Supplement)
• Medigap open enrollment
• MSP (Medicare Savings Programs)
• Observation status
• OHP (Oregon Health Plan)
• Original Medicare
• Out-of-pocket maximum
• PACE (Program of All-Inclusive Care for the Elderly)
• Part A
• Part B
• Part D
• PDP (Prescription Drug Plan)
• PPO (Preferred Provider Organization)
• Premium
• QMB (Qualified Medicare Beneficiary)
• SEP (Special Enrollment Period)
• SMP (Senior Medicare Patrol)
• SNF (Skilled Nursing Facility)
• SNP (Special Needs Plan)
• Star Ratings
• TPMO (Third-Party Marketing Organization)

Frequently asked questions

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