Expanded Medicare Glossary

This is based on the Medicare.gov glossary, but has additional or more specific terms, links to Medicare.gov pages, and is easier to browse.

Expanded Medicare Glossary
Benefit period	The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you're admitted as an inpatient in a hospital or SNF. The benefit period ends when you haven't gotten any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. The benefit period is not tied to the calendar year. There is no limit to the number of benefit periods you can have, or how long a benefit period can last. See Medicare.gov.
Coinsurance	An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%). See Medicare.gov.
Copayment or copay	An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription drug. See Medicare.gov.
Cost sharing	Costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments or similar charges, but it doesn't include premiums or the cost of non-covered services. The term is also used to describe lower-cost plans with lower premiums from lower coverage. See Medicare.gov.
Coverage gap (prescription drug)	A period of time in which you pay higher cost sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. The coverage gap (also called the “donut hole”) starts when you and your plan have paid a set dollar amount for prescription drugs during that year. See Medicare.gov.
Deductible	The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. See Medicare.gov.
Durable medical equipment	Certain medical equipment, like a walker, wheelchair, or hospital bed, ordered by your doctor for use in the home. See Medicare.gov.
Excess charge	If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge. See Medicare.gov.
Fee-for-service	A plan where hospitals and providers charge Medicare and patients for each service provided, rather than a single member fee for all services. Original Medicare Parts A and B are fee-for-service plans. Medicare Advantage plans that are HMOs or PPOs and not Private Fee-for-Service plans are paid a single amount by Medicare per plan enrollee. See Medicare.gov.
High-deductible policy	A type of policy that has a high deductible but a lower premium. You must pay the deductible before the policy pays anything. The deductible amount can change each year. See Medicare.gov.
HMO	Health Maintenance Organization, a plan that provides Medicare Advantage (Part C) benefits through health care providers or hospitals in the plan's network. See Medicare.gov.
Hospice	A special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient's family or caregiver. See Medicare.gov.
Initial Enrollment Period	A 7-month period for Part A and/or B enrollment from 3 months before to 3 months after the month you turn 65. If you are continuing work coverage past 65, there is a Special Enrollment Period. See Medicare.gov.
Late enrollment penalty	If you don't sign up for Part B during your initial or Special enrollment periods, you'll have to pay a permanent late enrollment premium penalty of 10% for each full 12-month period that you could have had Part B. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll, with coverage not starting until July 1. See Medicare.gov.
Medically necessary	Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. See Medicare.gov.
Medical Savings Account (MSA)	A savings account to pay for health care costs before you meet the deductible. Combined with a high-deductible insurance plan the Medical Savings Account forms a Medicare MSA Plan similar to Health Savings Account Plans available outside of Medicare. See Medicare.gov.
Medical underwriting	The process that an insurance company uses to decide, based on your medical history, whether to take your application for insurance, whether to add a waiting period for pre-existing conditions (if your state law allows it), and how much to charge you for that insurance. See Medicare.gov.
Medicare Advantage	See Part C below.
Medicare Advantage Open Enrollment	From October 15 to December 7 each year you can make changes to your Medicare Advantage coverage for the following year. Changes include switching between Original Medicare and a Medicare Advantage Plan, switching Medicare Advantage Plans, or adding or dropping drugs with Medicare Advantage. See Medicare.gov.
Medicare-approved amount	The amount a doctor or supplier that accepts Medicare assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you're responsible for the difference. See Medicare.gov.
Medigap	Extra health insurance from a private company for costs not covered by Original Medicare, such as co-payments, deductibles, and travel outside the U.S. See Medicare.gov.
Medigap Open Enrollment	A single six-month period that automatically starts the month you're 65 and enrolled in Medicare Part B. If you want to change Medigap insurance after this initial period, you can be subject to medical underwriting and consideration of your medical history and current health in approving and pricing plans. See Medicare.gov.
Part A	Hospital insurance that covers hospital inpatient care, short-term skilled nursing facility care, hospice care, and part-time or intermittent home health care. Doctors and other health care providers are covered by Part B for both inpatient and outpatient services. Part A and/or Part B can pay for home health care. See Medicare.gov.
Part B	Medical insurance that covers both inpatient and outpatient services from doctors and other health care providers, outpatient care, part-time or intermittent home health care, durable medical equipment, and preventive services like flu shots and screening mammograms. Part A and/or Part B can pay for home health care. Medicare.gov.
Part C	Medicare Advantage, an insurance plan from a Medicare-approved private company that covers Parts A and B, may include Part D prescription drugs, and may include extra benefits not covered by Medicare, for an extra cost. See Medicare.gov.
Part D	Insurance from a Medicare-approved private company that covers prescription drugs. Medicare.gov.
PPO	Preferred Provider Organization, a plan offered by a private insurance company with a network of health care providers and hospitals. See Medicare.gov.
Prescription Drug Open Enrollment	From October 15 to December 7 each year, you can make changes to your prescription drug coverage for the following year. Changes include joining, switching, or dropping plans. See Medicare.gov.
SHIP	State Health Insurance Assistance Program. See Medicare.gov.
Special Enrollment Period	If you are working and covered by a group health plan through the employer or union based on that work, you also have an 8-month enrollment period for Part A and/or B starting the month after the employment or the insurance ends, whichever comes first. See Medicare.gov.