- AEP (Annual Enrollment Period)
- The yearly window, October 15 to December 7, when anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D drug plan. Changes take effect January 1.
- OEP (Medicare Advantage Open Enrollment)
- January 1 to March 31. People already in a Medicare Advantage plan can switch to another MA plan or return to Original Medicare once during this window.
- IEP (Initial Enrollment Period)
- The 7-month window around your 65th birthday — the three months before, your birthday month, and the three months after — when you first sign up for Medicare.
- SEP (Special Enrollment Period)
- A window outside the normal periods, triggered by a life event such as moving, losing employer coverage, or a plan leaving your area, that lets you change Medicare coverage.
- IRMAA (Income-Related Monthly Adjustment Amount)
- An income-based surcharge added to Medicare Part B and Part D premiums for higher earners. It is based on your MAGI from two years prior. (See the IRMAA Calculator for current-year brackets.)
- MAGI (Modified Adjusted Gross Income)
- Your adjusted gross income plus tax-exempt interest. Medicare uses your MAGI from two years ago to decide whether you owe the IRMAA surcharge.
- Part A
- The hospital-insurance part of Medicare. It covers inpatient hospital stays, skilled nursing, hospice, and some home health care. Most people pay no premium for Part A.
- Part B
- The medical-insurance part of Medicare. It covers doctor visits, outpatient care, preventive services, and durable medical equipment, for a monthly premium.
- Part C (Medicare Advantage)
- An all-in-one alternative to Original Medicare offered by private insurers. It bundles Part A and Part B, usually adds Part D drug coverage, and often includes extras like dental or vision.
- Part D
- Medicare's prescription-drug coverage, sold by private plans. It can be a standalone plan added to Original Medicare or built into a Medicare Advantage plan.
- Medigap (Medicare Supplement)
- Private insurance that pays some of the out-of-pocket costs Original Medicare leaves behind, such as copays, coinsurance, and deductibles. It does not work with Medicare Advantage.
- MOOP (Maximum Out-of-Pocket)
- The yearly cap on what a Medicare Advantage member pays for covered medical services. Once they hit it, the plan pays 100% of covered care for the rest of the year.
- Coverage Gap (Donut Hole)
- A former phase of Part D where members paid more once drug spending hit a threshold. Starting in 2025 it was replaced by a hard annual out-of-pocket cap on Part D drug costs.
- LEP (Late Enrollment Penalty)
- A permanent surcharge added to your Part B or Part D premium if you go without creditable coverage after you were first eligible. (See the Penalty Calculator.)
- MSP (Medicare Savings Program)
- State programs that help pay Medicare premiums, and sometimes deductibles and coinsurance, for people with limited income.
- Star Ratings
- CMS's 1-to-5 quality scores for Medicare Advantage and Part D plans, based on member experience, outcomes, and service. Higher-rated plans can market year-round.
- Guaranteed Issue
- Times when an insurer must sell you a Medigap policy without medical underwriting and cannot charge more for health history — for example, when you lose other coverage.
- SOA (Scope of Appointment)
- A CMS-required form documenting which product types a beneficiary agreed to discuss before a sales appointment. Under the CY2027 final rule (91 FR 17384), it must be agreed before the appointment begins — the prior 48-hour advance requirement is eliminated effective October 1, 2026 (it still applies through September 30, 2026).
- CTM (Complaint Tracking Module)
- The CMS system where Medicare complaints against agents and plans are logged. A pattern of CTMs can trigger oversight, so agents keep clean documentation.
- Chargeback
- When an insurer reclaims commission already paid because a policy lapses, is canceled, or the member disenrolls inside the early-months window. Common in Medicare and final expense.
- Persistency
- The percentage of an agent's policies that stay in force over time. Carriers watch persistency closely; low persistency can cost an agent their contract.
- TCPA (Telephone Consumer Protection Act)
- The federal law governing telemarketing calls and texts. Agents must have documented consent to contact leads and honor do-not-call requests, or risk steep per-contact penalties.
- Original Medicare
- The traditional fee-for-service program run by the federal government — Part A plus Part B. Members can see any provider that accepts Medicare and may add Medigap and Part D.
- ANOC (Annual Notice of Change)
- The document a Medicare Advantage or Part D plan mails each fall showing what's changing — premium, copays, drugs, network — for the coming year. The trigger for the annual plan review.
- Formulary
- A plan's list of covered prescription drugs, organized into cost tiers. A drug's tier and rules (like prior authorization) determine what the member pays.
- Prior Authorization
- A plan requirement that a provider get approval before a service or drug is covered. A common reason a claim is delayed or denied.
- Network (HMO / PPO)
- The doctors and hospitals a Medicare Advantage plan contracts with. HMOs generally require in-network care and referrals; PPOs allow out-of-network care at higher cost.
- Creditable Coverage
- Drug coverage at least as good as Medicare Part D. Keeping creditable coverage avoids the Part D late-enrollment penalty.
- Ready-to-Sell (RTS)
- The status an agent reaches for a given carrier after completing AHIP plus that carrier's annual certification and contracting. An agent cannot sell a plan until RTS for it.
- AHIP
- America's Health Insurance Plans certification — the annual training and test most carriers require before an agent can sell Medicare Advantage or Part D plans for the year.
- FMO / IMO
- Field/Independent Marketing Organization — the upline that contracts agents with carriers and provides support, leads, and tools. Agents write business 'through' an FMO.
- AOR (Agent of Record)
- The agent officially credited with a policy, and who receives its commission. AOR changes are tightly controlled by CMS rules.
- Rapid Disenrollment
- When a member leaves a plan within roughly the first three months. It usually triggers a full commission chargeback to the agent.
- E&O Insurance
- Errors & Omissions insurance — professional liability coverage most carriers require an agent to carry before contracting.
- Effectuation
- The point at which an enrollment is accepted and the policy becomes active. Commission is typically paid after a policy effectuates.
- T65 (Turning 65)
- Consumers approaching age 65 and their Initial Enrollment Period — the highest-value prospects for a Medicare agent.
- Book of Business
- The full set of clients and active policies an agent has written. Retaining the book (high persistency) is where long-term renewal income comes from.