Medicare Glossary

Medicare Advantage Prescription Drug Plan (MA-PD)

A Medicare Advantage plan that bundles medical coverage (Part A and B) together with prescription drug coverage (Part D) into a single plan.

Also known as: MA-PD

Medicare Part C

The formal name for Medicare Advantage. A type of Medicare coverage offered by private insurers that combines Part A, Part B, and usually Part D coverage into one plan.

Also known as: Medicare Advantage

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

Service Area

The geographic area where a Medicare Advantage or Part D plan is available and provides coverage. Plans may have different networks and costs in different parts of their service area. Moving outside a plan's service area may trigger a Special Enrollment Period.

Star Ratings

A 1–5 star quality rating system that CMS uses to measure how well Medicare Advantage and Part D plans perform. Ratings are based on measures including member experience, customer service, and managing chronic conditions. Higher-rated plans may receive bonus payments.

Also known as: CMS Star Ratings, Quality ratings

Utilization Management

Processes used by Medicare Advantage and Part D plans to ensure services and drugs are medically appropriate and used efficiently. Includes prior authorization, step therapy, and quantity limits.

Also known as: UM, Utilization review