Glossary
Insurance terms, defined plainly
The words that show up on your policy, your Medicare mail and my pages, explained in a sentence or two each, with the New York rules where they differ. Figures are for 2026 and change each January.
Medicare and Social Security
- Medicare Part A
- Hospital insurance: inpatient stays, skilled nursing after a hospital stay, hospice and some home health. Premium-free for most people with 40 quarters of Medicare-covered work.
- Medicare Part B
- Medical insurance: doctors, outpatient care, tests and equipment. Has a monthly premium ($202.90 in 2026) and an annual deductible ($283 in 2026), then generally 20% coinsurance with no out-of-pocket cap.
- Medicare Advantage (Part C)
- A private plan approved by Medicare that replaces how you receive Parts A and B, usually with a network, drug coverage and extras, and a yearly out-of-pocket maximum.
- Medicare Part D
- Prescription drug coverage, from a standalone plan or built into a Medicare Advantage plan. Out-of-pocket drug costs are capped at $2,100 in 2026.
- Medigap (Medicare Supplement)
- A standardized private policy (Plans A to N) that pays what Original Medicare leaves to you. In New York it is guaranteed issue year-round and community rated.
- Community rating
- New York's rule that everyone on a given Medigap plan with a given carrier pays the same premium regardless of age or health.
- Guaranteed issue
- The right to buy a Medigap policy without medical underwriting. Federal law grants it in limited situations; New York grants it at all times.
- Initial Enrollment Period (IEP)
- The seven months around your 65th birthday (three before, the month of, three after) when you first enroll in Medicare.
- Annual Enrollment Period (AEP)
- October 15 to December 7 each year, when anyone on Medicare can change Medicare Advantage or Part D plans for January 1.
- Medicare Advantage Open Enrollment Period
- January 1 to March 31, when people already in a Medicare Advantage plan can make one change, including returning to Original Medicare.
- Special Enrollment Period (SEP)
- A window to enroll or change plans outside the normal periods, triggered by events such as moving, losing employer coverage, a plan non-renewal, or qualifying for Extra Help.
- Late enrollment penalty
- A permanent premium surcharge for enrolling late without creditable coverage: 10% of the Part B premium per full 12 months delayed; 1% of the Part D base premium per month without creditable drug coverage after 63 days.
- Creditable coverage
- Coverage at least as good as Medicare's, which lets you delay Part B or Part D without penalty. Employer coverage from a large employer is creditable for Part B; VA drug coverage is creditable for Part D.
- IRMAA
- Income-Related Monthly Adjustment Amount: a Part B and Part D surcharge for higher incomes, based on the tax return from two years earlier (above $109,000 single or $218,000 joint for 2026).
- Medicare Savings Program (MSP)
- State Medicaid programs that pay the Part B premium and, for QMB, Medicare cost-sharing. New York has no asset test and income limits up to 186% of the federal poverty level.
- QMB (Qualified Medicare Beneficiary)
- The MSP level that pays the Part B premium and all Medicare deductibles, copays and coinsurance; providers may not bill QMB members for Medicare cost-sharing.
- Extra Help (Low-Income Subsidy)
- A federal program that reduces Part D premiums, deductibles and copays for people with limited income and resources.
- EPIC
- Elderly Pharmaceutical Insurance Coverage, New York's state program that reduces Part D costs to $3 to $20 copays for residents 65 and over with income up to $75,000 single or $100,000 married.
- Dual eligible
- A person with both Medicare and Medicaid. Full duals have full Medicaid; partial duals have a Medicare Savings Program only.
- D-SNP
- Dual Eligible Special Needs Plan: a Medicare Advantage plan only for people with Medicare and Medicaid, coordinating both.
- Scope of Appointment
- A federally required form recording which Medicare products a beneficiary agreed to discuss with an agent before the meeting.
- Full Retirement Age (FRA)
- The age at which you receive 100% of your Social Security retirement benefit: 67 for anyone born in 1960 or later.
- Delayed retirement credits
- The 8% per year increase in Social Security benefits for each year you delay claiming past full retirement age, up to age 70.
- RSSA
- Registered Social Security Analyst: a credential from the National Association of Registered Social Security Analysts for professionals trained in Social Security claiming analysis.
Auto, home and personal
- No-fault (Personal Injury Protection)
- New York's requirement that your own auto policy pay your medical bills and part of lost wages after a crash regardless of fault, at least $50,000 basic PIP.
- SUM coverage
- Supplementary Uninsured/Underinsured Motorist coverage: pays for your injuries when the at-fault driver has no or insufficient insurance. Included at your liability limits in New York unless declined.
- Liability limits (25/50/10)
- Shorthand for bodily injury per person / per accident / property damage, in thousands. New York's minimum is $25,000 / $50,000 / $10,000.
- Collision
- Coverage for damage to your own vehicle from a crash, regardless of fault, subject to a deductible.
- Comprehensive
- Coverage for damage to your own vehicle from causes other than collision: theft, deer, hail, glass, fire, flood.
- Replacement cost
- Claim settlement that pays what it costs to replace property new, without deducting depreciation.
- Actual cash value (ACV)
- Claim settlement that pays replacement cost minus depreciation. Common on older roofs.
- Water backup endorsement
- An add-on to a homeowners policy covering water that backs up through sewers, drains or a failed sump pump, which the standard policy excludes.
- Loss assessment
- Condo coverage that pays your share of a loss or deductible the association assesses to unit owners.
- HO-6
- The standard condominium unit-owners policy form.
- DP-3
- The standard dwelling fire policy form for rental property, on an open-perils, replacement-cost basis.
- Personal umbrella
- Liability coverage of $1 million or more that sits above auto, home and boat policies.
- NFIP
- The National Flood Insurance Program, the federal flood insurance program administered by FEMA, with a 30-day waiting period on most new policies.
- Declarations page
- The summary page of an insurance policy showing named insureds, coverages, limits, deductibles and premium.
Life and health
- Term life insurance
- Life insurance that pays a death benefit if you die within a set term (10, 20 or 30 years) at a level premium, with no cash value.
- Whole life insurance
- Permanent life insurance with guaranteed premiums, a guaranteed death benefit and a cash value that grows over time.
- Regulation 187
- New York's rule requiring life insurance and annuity recommendations to be in the consumer's best interest, in force since 2019 (annuities) and 2020 (life).
- Own-occupation disability
- A disability policy definition that pays if you cannot perform your own occupation, even if you could do other work.
- Elimination period
- The waiting period between the start of a disability and the start of benefit payments, commonly 90 days.
- Essential Plan
- New York's $0-premium health plan through NY State of Health for adults 19 to 64 with income up to 200% of the federal poverty level.
- COBRA
- The federal right to continue employer group health coverage after leaving a job, typically for 18 months, at full cost plus 2%.
- Long-term care insurance
- Insurance that pays for custodial care at home, in assisted living or in a nursing home, which Medicare does not cover.
Business insurance
- General liability (GL)
- Coverage for bodily injury and property damage to third parties arising from your premises, operations, products and completed work.
- Business owners policy (BOP)
- A package combining general liability, property and business income coverage for small businesses.
- Workers' compensation
- Mandatory coverage in New York from the first employee, paying medical care and lost wages for work-related injury or illness regardless of fault.
- DBL (Disability Benefits Law)
- New York's mandatory employer coverage for employees' off-the-job illness or injury: 50% of wages up to $170 a week for 26 weeks.
- Paid Family Leave (PFL)
- New York's mandatory, employee-funded coverage for up to 12 weeks of job-protected leave to bond with a child or care for a family member, paying 67% of wages up to $1,228.53 a week in 2026.
- Certificate of insurance (COI)
- A document summarizing a policy's coverages and limits, issued to landlords, clients and general contractors as proof of insurance.
- Additional insured
- A person or organization added to your policy by endorsement so it is covered for claims arising from your work; not the same as a certificate holder.
- Waiver of subrogation
- An endorsement giving up your insurer's right to recover from a specified party, commonly required by general contractors and landlords.
- Liquor liability
- Coverage for claims under New York's Dram Shop Act by third parties injured by a person you unlawfully served alcohol.
- Dram Shop Act
- New York General Obligations Law §11-101, which makes a business liable for injuries caused by a person it served while visibly intoxicated or under 21.
- Professional liability (E&O)
- Coverage for claims that your advice or professional service caused a financial loss.
- Employment practices liability (EPLI)
- Coverage for employee claims of discrimination, harassment, retaliation and wrongful termination.
- Inland marine
- Coverage for property that moves: tools, equipment, cargo and installation materials.
- Garagekeepers
- Coverage for customers' vehicles in the care of an auto repair shop, dealer or valet.
- Hired and non-owned auto
- Liability coverage for vehicles your business rents or that employees drive for business in their own cars.
- Business income (business interruption)
- Coverage for lost income and continuing expenses while a business is closed after a covered property loss.
- Experience modification (mod)
- A factor applied to workers' compensation premium reflecting your claims history relative to businesses like yours.
- Payroll audit
- The year-end review that adjusts a workers' compensation or general liability premium to actual payroll or sales.
- Labor Law §240(1)
- New York's Scaffold Law, imposing strict liability on owners and contractors for gravity-related injuries to construction workers.
Missing a term? Ask and I'll add it. For the full explanations, see the guides and the list of every line I offer.
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