Reference

Washington Medicare glossary

Plain-language definitions of the Medicare words you'll see on notices, plan documents and enrollment forms, plus the Washington names that come up alongside Medicare: Apple Health (Washington's Medicaid program), the Health Care Authority, DSHS, the Office of the Insurance Commissioner, PEBB, SEBB and the WA Cares Fund.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 9, 2026

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

ABN (Advance Beneficiary Notice of Noncoverage)

A form a doctor, lab or supplier with Original Medicare gives you before a service when they think Medicare may not pay for it. If you sign it and get the service, you may have to pay if Medicare denies the claim. You can still ask them to bill Medicare so you keep your right to appeal.

AEP (Annual Enrollment Period)

October 15 to December 7 each year, when you can join, switch or drop a Medicare Advantage plan or a Part D drug plan. Changes take effect January 1. Medicare also calls it the Open Enrollment Period. The AEP for 2027 coverage runs October 15 to December 7, 2026. See the open enrollment guide.

Area Agency on Aging (AAA)

A local agency that plans and provides services for older adults and caregivers, such as in-home care, meals, caregiver support and help finding long-term care. Washington's Area Agencies on Aging are reached through Community Living Connections.

Appeal

A request to review a decision not to cover or pay for a service, item or drug. Medicare appeals have five levels, and the first step and deadline are printed on your notice. See Medicare appeals in Washington.

Apple Health

The name of Washington's Medicaid program, run by the Washington State Health Care Authority (HCA). For people 65 and older or with a disability, DSHS decides eligibility for Apple Health, the Medicare Savings Programs and long-term care. People with both Medicare and Apple Health are called dual eligible. See Apple Health and Medicare and Medicare vs. Apple Health.

Assignment

A provider's agreement to accept the Medicare-approved amount as full payment for covered services. If your doctor accepts assignment, you pay only your deductible and coinsurance, and the doctor bills Medicare for you.

Benefit period

How Original Medicare measures your use of hospital and skilled nursing care. It starts the day you're admitted as an inpatient and ends when you've had no inpatient or skilled nursing care for 60 days in a row. You pay the Part A deductible ($1,736 in 2026) for each benefit period, so you can owe it more than once a year.

CLC (Community Living Connections)

Washington's statewide network for aging and long-term care services, reached at 1-855-567-0252 or waclc.org. It connects you with your local Area Agency on Aging. See Community Living Connections.

CMS (Centers for Medicare & Medicaid Services)

The federal agency that runs Medicare, approves Medicare Advantage and Part D plans, and oversees state Medicaid programs such as Apple Health. Social Security handles Medicare sign-up.

Coinsurance

Your share of a covered cost, as a percentage. After the Part B deductible, you usually pay 20% of the Medicare-approved amount for doctor visits and outpatient care under Original Medicare.

Copayment (copay)

A set dollar amount you pay for a service or prescription, such as a doctor visit or a 30-day supply of a drug. Medicare Advantage and Part D plans set their own copays.

Creditable coverage

Drug coverage expected to pay on average at least as much as standard Part D. Keeping creditable coverage, for example from a job, PEBB, the VA, TRICARE or tribal and Indian Health Service programs, protects you from the Part D late enrollment penalty. Your plan tells you each year in a creditable coverage notice. For Part B, what lets you delay without a penalty is group health coverage from current work, yours or your spouse's.

D-SNP (Dual Eligible Special Needs Plan)

A Medicare Advantage plan only for people who have both Medicare and Medicaid (in Washington, Apple Health). D-SNPs coordinate the two programs and must have a contract with the state. See D-SNPs in Washington.

Deductible

What you pay before Medicare or your plan starts to pay. In 2026 the Part A deductible is $1,736 per benefit period, the Part B deductible is $283 a year, and Part D plans can have a deductible of up to $615.

DME (durable medical equipment)

Equipment your doctor orders for use at home, such as walkers, wheelchairs, hospital beds, oxygen equipment and CPAP machines. Part B covers it when you get it from a supplier enrolled in Medicare.

DSHS (Washington State Department of Social and Health Services)

The state agency that decides eligibility for Apple Health for people 65 and older, blind or with a disability, and for the Medicare Savings Programs, and that runs long-term care and aging services through its Aging and Long-Term Support Administration. Customer service: 1-877-501-2233.

Dual eligible

A person who has both Medicare and Medicaid (Apple Health). Full dual eligibles get full Apple Health benefits; partial dual eligibles get help only through a Medicare Savings Program. Medicare pays first, then Apple Health.

EOB (Explanation of Benefits)

A statement from a Medicare Advantage or Part D plan showing the services or drugs it paid for, what it paid and what you may owe. It is not a bill. Part D EOBs also show your progress toward the yearly out-of-pocket cap.

Evidence of Coverage (EOC)

A Medicare Advantage or Part D plan's full description of what it covers, what you pay and its rules, sent each fall for the coming year. If the plan changes for next year, the Annual Notice of Change lists what's different.

Extra Help

A federal program, also called the Part D Low-Income Subsidy, that helps pay Part D premiums, deductibles and copays. In 2026 the yearly income limit is $23,940 for one person. People with Apple Health or a Medicare Savings Program qualify automatically; others apply through Social Security. See Extra Help in Washington.

FEHB (Federal Employees Health Benefits)

Health insurance for federal employees and retirees. Retirees can keep FEHB with Medicare, and deciding whether to add Part B is an important choice. See FEHB and Medicare.

Formulary

A plan's list of covered drugs, usually sorted into tiers. Formularies differ from plan to plan and can change each year, so check that your drugs are on it before you join.

GEP (General Enrollment Period)

January 1 to March 31 each year, for people who missed their Initial Enrollment Period and don't qualify for a Special Enrollment Period. Coverage starts the month after you sign up, and a late enrollment penalty may apply.

Guaranteed issue rights

Situations in which a Medigap company must sell you a policy and can't charge more for health conditions, for example during your 6-month Medigap open enrollment period or when your Medicare Advantage plan leaves your area. Federal law sets these rights, and Washington adds its own rules for switching Medigap policies; see Medigap in Washington.

HCA (Washington State Health Care Authority)

The state agency that runs Apple Health (Medicaid) and the PEBB and SEBB benefit programs for public and school employees and retirees. Apple Health customer service: 1-800-562-3022.

HMO (Health Maintenance Organization)

A type of Medicare Advantage plan that generally requires you to use doctors and hospitals in its network, except for emergencies and urgently needed care. Some HMOs require referrals to see specialists.

IEP (Initial Enrollment Period)

Your first chance to sign up for Medicare: seven months that start three months before the month you turn 65 and end three months after it. Signing up before your birthday month means coverage starts the month you turn 65. See turning 65 in Washington.

IHS (Indian Health Service)

The federal agency that provides health care to members of federally recognized tribes. Washington's 29 federally recognized tribes are served by the IHS Portland Area, along with tribal and urban Indian programs. See tribal health and Medicare.

IRMAA (Income-Related Monthly Adjustment Amount)

An extra amount added to Part B and Part D premiums for people with higher income. For 2026 it applies when modified adjusted gross income from your 2024 tax return was above $109,000 (single) or $218,000 (married filing jointly). The brackets are cliffs: one dollar over a line moves you to the next amount. See IRMAA in Washington or try the IRMAA calculator.

Late enrollment penalty

An amount added to your premium if you sign up late. For Part B it is 10% for each full 12 months you could have had Part B but didn't, usually for as long as you have Part B. For Part D it applies after 63 days or more in a row without Part D or creditable coverage. See late enrollment penalties and the penalty calculator.

LTSS (long-term services and supports)

Help with daily activities over a long period, such as in-home care, adult family homes, assisted living and nursing facility care. Medicare generally doesn't pay for long-term custodial care. In Washington, Apple Health long-term care and the WA Cares Fund may help people who qualify.

MA OEP (Medicare Advantage Open Enrollment Period)

January 1 to March 31 each year. If you're in a Medicare Advantage plan, you can switch to another one or go back to Original Medicare (and join a Part D plan) once during this time. People new to Medicare Advantage also get it during their first three months of Medicare.

Medicare Advantage (Part C)

Plans from private companies approved by Medicare that provide your Part A and Part B coverage, usually with drug coverage, through a network. Plans are approved county by county; for 2027, 14 companies offer Medicare Advantage plans in Washington (CMS plan data). See Medicare Advantage in Washington.

Medicare-approved amount

The amount Medicare sets as payment for a covered service. Your coinsurance is a share of this amount. A provider who doesn't accept assignment may charge up to 15% more (an excess charge).

Medicare Summary Notice (MSN)

A statement Original Medicare mails every four months if you had services, listing what providers billed, what Medicare paid and the most you may owe. It's not a bill, and it explains how to appeal. You can also see claims in your Medicare.gov account. See fraud prevention.

Medigap (Medicare Supplement Insurance)

Private insurance that works with Original Medicare to pay some of what it leaves, such as deductibles and the 20% coinsurance. Plans are standardized by letter (A, B, C, D, F, G, K, L, M, N), so the same letter has the same benefits from every company; prices differ. The Office of the Insurance Commissioner regulates Medigap in Washington. See Medigap in Washington.

Medigap open enrollment period

A one-time, 6-month period that starts the month you are 65 or older and enrolled in Part B. During it, a Medigap company must sell you any policy it sells in Washington, without health questions.

MOOP (maximum out-of-pocket limit)

The most you pay in a year for covered Part A and Part B services in a Medicare Advantage plan. CMS sets the highest limit plans may use ($9,250 for in-network services in 2026); each plan sets its own. Original Medicare has no such limit.

MSP (Medicare Savings Programs)

Programs, part of Apple Health, that pay Medicare premiums, and for some people deductibles and coinsurance. Washington offers QMB, SLMB and QI-1 (and QDWI for some working people with disabilities), with no resource test since January 1, 2023. Apply through DSHS or Washington Connection. See Medicare Savings Programs in Washington.

Network

The doctors, hospitals, pharmacies and other providers a plan contracts with. Medicare Advantage HMOs generally cover only in-network care except emergencies and urgently needed care; PPOs also pay for out-of-network care at a higher cost to you. Original Medicare has no network.

OIC (Washington State Office of the Insurance Commissioner)

The state agency that regulates insurance companies and licenses insurance agents in Washington, including those selling Medigap. Medicare Advantage and Part D plans are regulated mainly by CMS. You can file a complaint about an insurance company or agent at insurance.wa.gov. The OIC also runs Washington's Senior Medicare Patrol.

Original Medicare

Part A and Part B, run by the federal government. You can use any doctor or hospital in the U.S. that accepts Medicare, and you can add a Medigap policy and a Part D plan.

Part A (hospital insurance)

Covers inpatient hospital stays, skilled nursing care after a qualifying stay, hospice and some home health care. Most people pay no premium for Part A because they or a spouse paid Medicare taxes for at least 10 years. See Part A.

Part B (medical insurance)

Covers doctor visits, outpatient care, lab tests, durable medical equipment and preventive services. The standard premium is $202.90 a month in 2026. See Part B.

Part C

Another name for Medicare Advantage.

Part D (prescription drug coverage)

Drug coverage from private plans, either a standalone Part D plan with Original Medicare or as part of a Medicare Advantage plan. In 2026 your out-of-pocket costs for covered drugs are capped at $2,100 for the year, and covered insulin costs no more than $35 for a month's supply. Washington and Oregon form one Part D region, so the same standalone plans are offered across Washington. See Part D in Washington.

PEBB (Public Employees Benefits Board)

The Health Care Authority program that provides health coverage to Washington state and higher-education employees and to eligible retirees, including school employees who retire. PEBB retiree coverage has its own rules for people with Medicare. See PEBB and Medicare.

POLST (Portable Orders for Life-Sustaining Treatment)

A medical order, signed by your health care provider, that records your wishes about life-sustaining treatment so emergency and hospital staff can follow them. It is meant for people with a serious illness or frailty, and it complements an advance directive. See end-of-life planning.

PPO (Preferred Provider Organization)

A type of Medicare Advantage plan with a network that also pays for covered care outside the network, usually at a higher cost to you.

Premium

The amount you pay each month for coverage. You pay the Part B premium even if you join a Medicare Advantage plan, plus any plan premium.

Prior authorization

Approval you or your provider must get from a plan before it will cover a service or drug. Medicare Advantage and Part D plans can require it for some services and drugs.

QI-1 (Qualifying Individual)

A Medicare Savings Program that pays your Part B premium. In Washington it covers incomes above 120% and up to 138% of the federal poverty level.

QMB (Qualified Medicare Beneficiary)

A Medicare Savings Program that pays Part A premiums (if you owe one), Part B premiums, and Medicare deductibles, coinsurance and copays. In Washington it covers incomes up to 110% of the federal poverty level. Providers may not bill people in QMB for Medicare-covered cost sharing.

Referral

A written order from your primary care doctor to see a specialist or get certain services. Some Medicare Advantage HMOs require one; Original Medicare usually doesn't.

SEBB (School Employees Benefits Board)

The Health Care Authority program that provides health coverage to Washington K–12 school district and educational service district employees. SEBB has no retiree plans: school employees who retire move to PEBB retiree coverage if they qualify. See SEBB and Medicare.

SEP (Special Enrollment Period)

A chance to sign up for or change coverage outside the usual windows because of a life event, such as moving, losing job-based coverage, your plan leaving your area, getting Apple Health or Extra Help, or a disaster declaration. See when you can change your plan.

Service area

The counties or ZIP codes where a Medicare Advantage plan is offered. You must live in the service area to join, and moving out of it gives you a Special Enrollment Period. See moving to Washington with Medicare.

Skilled nursing facility (SNF)

A facility with skilled nursing or rehab staff. Original Medicare covers up to 100 days per benefit period after a qualifying inpatient stay of at least three days; in 2026 you pay $217 a day for days 21 to 100. Medicare doesn't cover long-term custodial care.

SLMB (Specified Low-Income Medicare Beneficiary)

A Medicare Savings Program that pays your Part B premium. In Washington it covers incomes above 110% and up to 120% of the federal poverty level.

SMP (Senior Medicare Patrol)

A federally funded program that helps people with Medicare prevent, spot and report fraud, errors and abuse. In Washington, the Office of the Insurance Commissioner runs it. See Medicare fraud prevention in Washington.

SNP (Special Needs Plan)

A Medicare Advantage plan limited to people with certain needs: both Medicare and Medicaid (D-SNP), certain chronic conditions (C-SNP), or living in an institution (I-SNP). For 2027 there are 43 special needs plans in Washington (CMS plan data).

Star Ratings

CMS's 1-to-5-star quality ratings for Medicare Advantage and Part D plans, based on member experience, health outcomes and customer service. You can see them in Medicare's plan finder.

TPMO (third-party marketing organization)

CMS's term for agents, agencies and companies that sell Medicare plans for insurance companies. Benefits Life, the publisher of this site, is a TPMO, which is why each page shows the CMS disclaimer about the plans we represent.

TRICARE For Life (TFL)

Coverage for military retirees and eligible family members with Medicare that pays after Medicare. You must have Part A and Part B to keep it. See TRICARE For Life in Washington.

VA health care

Health care for eligible veterans from the Department of Veterans Affairs, which in Washington includes the Puget Sound, Spokane and Walla Walla VA systems. VA care and Medicare don't coordinate payment, so you generally use one or the other for each service. See VA and Medicare in Washington.

WA Cares Fund

Washington's state long-term care insurance program, paid for by a premium of 0.58% of Washington workers' wages. It pays for long-term care services and supports, up to a lifetime amount adjusted each year, for people who have earned eligibility by working and paying in. You stop paying in when you retire. It is separate from Medicare. See WA Cares Fund and Medicare.

Washington Connection

The state's online application site (washingtonconnection.org), run by DSHS, where you can apply for Apple Health for people 65 and older, blind or with a disability, the Medicare Savings Programs, long-term care services, and food and cash assistance.

Sources

Frequently asked questions

What is the difference between Apple Health and Medicare?

Medicare is the federal health insurance program for people 65 and older and some younger people with disabilities. Apple Health is Washington's Medicaid program, based on income and other rules, and run by the Health Care Authority. Some Washingtonians have both; Medicare then pays first, and Apple Health can help with premiums and costs Medicare leaves.

Is the WA Cares Fund part of Medicare?

No. WA Cares Fund is a Washington state long-term care insurance program paid for by a premium on Washington workers' wages. It can help pay for long-term care services that Medicare generally doesn't cover, for people who have earned eligibility by working and paying in.

Where can I look up a Medicare term that isn't on this page?

Medicare.gov has a full glossary, and 1-800-MEDICARE (1-800-633-4227) can explain any term on a Medicare notice. A licensed insurance agent with Benefits Life can also help you read plan documents, at no cost to you.

Medicare in your Washington county

Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima

Licensed insurance agents for Washington

These independent insurance agents are licensed in Washington and work with Benefits Life, the publisher of this site. When they enroll you in a plan, the agent and Benefits Life may be paid by the insurance company. Learn more.