IEP, IRMAA, and MOOP are Medicare buzzwords that hide deadlines and surcharges. Learn each term or use ALEX® to translate them instantly and stay penalty-free.
Most Common Medicare Buzzwords • FAQ • Stay Upright with ALEX
Whether you’re opening Medicare mailers for the first time or you’ve been on Part B for a decade, certain terms keep popping up—then tripping people flat. Think of them as the banana peels of Medicare: slippery acronyms and phrases that look harmless until premiums spike or deadlines pass.
Below are the most frequent—and most frequently misunderstood—Medicare buzzwords we hear about every day. Bookmark them for reference, and you’ll sidestep most of the classic enrollment pitfalls.
And remember, if you’re new to Medicare, you don’t need to tattoo these definitions on your forearm. ALEX®—our plain‑spoken, confidence-building, interactive guide—flags each buzzword in real time and translates it the moment it matters. So skim, bookmark, and relax. When the jargon shows up, ALEX has already done the homework.
A seven-month window—three months before, the month of, and three months after your 65th birthday—to sign up for Parts A and B penalty-free. It’s not a single day.
To be considered creditable, your employer or union insurance must have coverage that’s at least as good as Medicare Part B or D. If your plan isn’t creditable, late-enrollment penalties kick in when you finally join Medicare.
How to confirm it's creditable:
1. Ask HR for a written "creditable coverage" letter.
2. Re-verify each fall during your company's open enrollment season.
No. Part B starts at $202.9/mo in 2026 and rises with income (IRMAA). Add drug, Medigap, or Medicare Advantage premiums for your true cost.
The Income-Related Monthly Adjustment Amount is an extra surcharge on Parts B and D if your two-year-look-back income tops $109k for single filing or $218k for joint filing in 2026.
Often confused for the deductible, MOOP—Maximum Out-of-Pocket—is the plan’s annual spending cap. After you hit it, the plan pays 100% of covered services for the rest of the year.
People assume every plan covers every drug, but each Part D or MA-PD plan has its own drug list. Tiers are price buckets: Tier 1 generics are cheapest, while Tier 4 specialty drugs may cost 10× more.
Prior authorization lets a Medicare Advantage plan approve pricey tests, surgeries, durable medical equipment (DME), or certain drugs before you receive them. Most people think they’re just an HMO thing, but many PPOs require them too.
Part C = Medicare Advantage, a private alternative to Original Medicare that includes Parts A and B plus drug coverage. Part D = a stand-alone plan for prescription drug coverage.
A six-month window starting with Part B enrollment when insurers must sell you any Medigap plan at the best rate—no health questions allowed. Outside of that six-month window, underwriting may deny or cost you more.
Sometimes confused with balance billing, it’s up to 15% above Medicare’s approved amount that non-participating providers may bill. Medigap Plan G covers them; Plan N does not.
Patients assume a hospital stay = inpatient. But “under observation” is actually billed as outpatient, affecting your Part B costs and disqualifying you from Medicare-covered skilled-nursing care that requires a 3-day inpatient stay.
Up to 100 days per benefit period after a qualifying 3-day inpatient hospital stay. Beyond that, you pay the bill. It’s a common misconception that part A covers unlimited days.
Life events like moving, losing creditable coverage, or leaving an employer plan. An SEP lets you change Medicare plans outside the usual enrollment windows.
The coverage gap math changed in 2020, but out-of-pocket drug percentages still shift mid-year—so costs can jump even though the term persists.
Reusable, medically necessary, approved items such as wheelchairs or CPAP machines. Single-use supplies like bandages don’t count and aren’t covered under DME rules.
A receipt from your insurer detailing what was billed, plan discounts, and what you owe (if anything). It’s not a bill. The bill comes from your provider.
You may owe a 10% lifetime surcharge on Part B premiums for every 12 months you delay without creditable coverage.
IRMAA uses your tax return from two years ago. If your Modified Adjusted Gross Income (MAGI) tops $109k single/$218k joint in 2026, Parts B & D surcharges apply.
No. MOOP, or Maximum-Out-of-Pocket, is your annual spending ceiling in Medicare Advantage. After you hit it, the plan pays 100% of covered costs for the rest of the year.
When you’re enrolling in a Medicare plan for the first time, knowing the trickiest buzzwords is half the battle, but real peace of mind comes when someone keeps an eye out for them while you move forward. That’s ALEX’s specialty:
Bottom line: You don't need a PhD in Medicare to pick (and keep) a plan that fits today—and 10 years from now. Keep this glossary as your quick reference but let ALEX handle the heavy lifting and slip-prevention when it's time to enroll.
Ready to stop worrying about jargon and start choosing with confidence?
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