Medicare Glossary

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

A Medicare and Medicaid program that provides comprehensive medical and social services to help certain frail, older adults continue living in their community instead of a nursing home.

Also known as: PACE

Participating Provider

A doctor, hospital, or other health care provider who accepts Medicare assignment — meaning they agree to accept the Medicare-approved amount as full payment for covered services.

Also known as: Par provider

Preferred Provider Organization (PPO)

A type of Medicare Advantage plan that allows you to see any provider who accepts Medicare, but you pay less when you use the plan's preferred (in-network) providers. Unlike HMOs, PPOs generally do not require referrals for specialists.

Also known as: PPO

Premium

The amount you pay for your Medicare coverage, typically deducted monthly. Part A is premium-free for most people. Part B has a standard monthly premium (adjusted for income). Medicare Advantage and Part D plans have their own premiums in addition to Part B.

Prescription Drug Plan (PDP)

A stand-alone Medicare Part D plan that provides prescription drug coverage for people enrolled in Original Medicare. PDPs are separate from Medicare Advantage plans that already include drug coverage.

Also known as: PDP, Stand-alone Part D Plan

Preventive Services

Health care services that help detect or prevent illness and health problems. Medicare Part B covers many preventive services — such as mammograms, colonoscopies, flu shots, and the "Welcome to Medicare" visit — often at no cost to you.

Primary Care Provider (PCP)

The main doctor who manages your overall health care and refers you to specialists when needed. Some Medicare Advantage HMO plans require you to choose a PCP and get referrals from them before seeing a specialist.

Also known as: PCP, Primary care doctor

Prior Authorization

Approval that your Medicare Advantage or Part D plan may require before you receive certain services or medications. Without prior authorization, the plan may not cover the cost. Original Medicare rarely requires prior authorization.

Also known as: Preauthorization, Pre-approval