Medicare Glossary: Definitions for Medicare Terms

Appeal. A formal complaint that you can make if your Medicare health plan doesn't pay for a drug or medical service that you feel it should.

Approved amount. The price that Medicare is willing to pay for a specific medical service (when combined with your co-pay, if applicable). If your doctor charges more than the approved amount, you will have to pay the difference.

Co-insurance. What you must pay for a medical service or prescription drug. It is a percentage of the cost of that service or drug. 

Co-pays. What you must pay for a medical service or prescription drug. It is a flat fee.

Creditable prescription drug coverage. Drug coverage -- from an employer, for instance -- that offers benefits that are as good as or better than what Medicare offers.

Deductible. Money that you need to pay for medical care before your Medicare coverage kicks in. Once you have paid the deductible, Medicare starts to cover some of your costs.

Doughnut hole. The popular term for a gap in coverage in the some Medicare Drug Plans. Medicare calls it the "coverage gap."

Dual eligible. People who are eligible for both Medicare and Medicaid.

Durable medical equipment. Reusable equipment -- like wheelchairs, walkers, and hospital beds -- that your doctor orders for you to use at home.

Enrollment period. A limited period of time when you can enroll in or switch Medicare plans.

Extra help. Financial assistance for people with very limited incomes and assets that helps cover Medicare Prescription Drug Plan costs.

Grievance. A formal complaint that you can make to Medicare if you have been treated poorly by either your plan or by a staff member giving you medical care.

Home health care. Short-term medical care that Medicare provides at home while you recover from an injury or illness. It includes part-time or occasional skilled nursing care, some equipment, supplies, and other services.

Hospice care. Care for people who are terminally ill, which is covered by Medicare Part A. It includes physical care and counseling. It is usually done at home.

Long-term care. Ongoing help with personal and health care, which might be provided by a nursing home or assisted living facility. Medicare does not cover this kind of care.

Medicaid. A federal and state program separate from Medicare that helps pay medical costs for people with low incomes and limited assets.

Medicare Advantage. An alternative to Medicare Parts A and B, in which a private company provides your health care coverage.

Medicare Part A. Medicare insurance that pays for stays in the hospital and skilled nursing facilities, along with hospice care, and some home health care.

Medicare Part B. Medicare insurance that pays for doctor's visits, laboratory tests, medical equipment, and some other medical services.

Medicare Prescription Drug Plan (Medicare Part D.) The newest part of Medicare, which provides you with some coverage for prescription brand name and generic drugs.

Medigap. A private insurance policy that fills some of the gaps in your Medicare Part A and Part B coverage.

Occupational therapy. Therapy that helps you get back to normal after an illness, including assistance with meals, bathing, and housekeeping.

Original Medicare. The term for Medicare Parts A and B. 

Out-of-pocket costs. Fees that Medicare doesn't pay; you have to pay them yourself.

Premium. A regular payment, usually monthly, for coverage in a health plan.

Skilled nursing care. Medical care that is provided by a registered nurse (RN) or licensed practical nurse (LPN.)