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Medicare Glossary
Assignment
What is Medicare Assignment? An agreement by your doctor (or other healthcare providers) to be paid directly by Medicare, to...
Beneficiary
What is a Beneficiary? A person who has health care insurance through the Medicare or Medicaid programs.
Benefit Period
What is a Medicare Benefit Period? A benefit period is a method used in Original Medicare to measure a beneficiary’s...
Claim
What is a Medicare Claim? A claim is a request for payment that you submit to Medicare (or other health...
Comprehensive Outpatient Rehabilitation Facility
What is a Comprehensive Outpatient Rehabilitation Facility? A Comprehensive Outpatient Rehabilitation Facility is a facility that provides a variety of...
Coordination of Benefits
What is Coordination of Benefits in Medicare? Coordination of Benefits is a way to determine who pays first when two...
Cost Sharing
What is Medicare Cost Sharing? Medicare’s cost-sharing is the out-of-pocket costs that beneficiaries pay to receive medical services or supplies,...
Coverage Determination
What is a Medicare Part D Coverage Determination? A coverage determination is the first decision made by a Medicare Part...
Coverage Gap
What is the Medicare Part D Coverage Gap? The Medicare Part D coverage gap, also known as the donut hole,...
Creditable Coverage
What is Medicare Creditable Coverage? Creditable coverage refers to health insurance or prescription drug benefits that meet Medicare’s minimum qualifications...
Custodial Care
What is Custodial Care in Medicare? Custodial Care is non-skilled personal care, such as helping with activities of daily living...
Formulary
What is a Drug Formulary? A formulary is a list of prescription drugs covered by a prescription drug plan or...
Durable Medical Equipment
What is Durable Medical Equipment? Durable medical equipment (DME), also known as DMEPOS (Durable medical equipment, Prosthetics, and Supplies), is...
End-Stage Renal Disease
What is End-Stage Renal Disease (ESRD)? End-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes...
Exception
What is a Medicare Part D Exception? An exception in a Medicare Part D plan is a type of prescription...
Generic Drug
What is a Generic Drug? A generic drug is a prescription medication with the same active ingredient formula as a...
Grievance
What is a Medicare Advantage Grievance? A grievance is a complaint about how your Medicare Advantage health plan or Medicare...
Group Health Plan
What is a Group Health Plan? In general, an employer or employee organization offers a group health plan that provides...
Guaranteed Renewable Policy
What is a Guaranteed Renewable Policy? A guaranteed renewable policy is an insurance policy that the insurance company can’t terminate...
Health Care Provider
What is a Health Care Provider? A health care provider is a person or organization licensed to give health care....
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