What is an advance coverage decision in Medicare?

An advance coverage decision is a written decision made before you receive care that confirms whether Medicare will pay for a specific service or item.

What is a benefit period in Medicare?

A benefit period begins when you are admitted as an inpatient and ends after you have been out of the hospital or skilled nursing facility for 60 days in a row.

What is catastrophic coverage in Medicare Part D?

Catastrophic coverage is the phase where you pay $0 for covered drugs after spending $2,000 out-of-pocket in 2026.

What is a copayment in Medicare?

A copayment is a fixed amount you pay for a covered service, such as $20 for a primary care visit, with Medicare paying the rest.

What is creditable coverage in Medicare?

Creditable coverage is drug coverage from another source that is as good as Part D, which lets you delay Part D enrollment without a late penalty.

What is a formulary in Medicare?

A formulary is the list of covered prescription drugs for a Medicare drug plan, organized into tiers that determine your out-of-pocket cost.

What is the Initial Enrollment Period for Medicare?

The Initial Enrollment Period is the 7-month window around your 65th birthday when you can first enroll in Medicare Parts A, B, and D without penalty.

What is the Medicare late enrollment penalty?

The late enrollment penalty is a permanent increase to your premium for enrolling in Medicare Part B or Part D after your Initial Enrollment Period ends without having other qualifying coverage.

What is Medicare Advantage (Part C)?

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare offered by private insurers, which often includes extra benefits like dental, vision, and drug coverage.

What does Medicare Part A cover?

Medicare Part A covers inpatient hospital care, skilled nursing facility stays, hospice, and some home health services.

What does Medicare Part B cover?

Medicare Part B covers outpatient medical care including doctor visits, lab work, preventive services, and durable medical equipment.

What is a Medicare Supplement plan (Medigap)?

A Medicare Supplement plan (Medigap) is private insurance sold to help pay Original Medicare's cost-sharing amounts such as deductibles, copays, and coinsurance.

What is the Medigap Open Enrollment Period?

The Medigap Open Enrollment Period is the 6-month guaranteed-issue window when you turn 65 and enroll in Part B, during which no insurer can deny you a Medigap policy.

Does Medicare have an out-of-pocket maximum?

Original Medicare has no out-of-pocket cap, but Medicare Advantage plans are required to set an annual out-of-pocket maximum.

What preventive services does Medicare cover for free?

Medicare Part B covers screenings like mammograms and colonoscopies, flu shots, and annual wellness visits at no cost when you see a participating provider.

What is a skilled nursing facility in Medicare?

A skilled nursing facility (SNF) provides short-term rehabilitative care after a hospital stay, covered by Medicare Part A for up to 100 days.

What is a Medicare Special Enrollment Period?

A Special Enrollment Period is a window to enroll in or change Medicare coverage outside normal enrollment periods due to a qualifying event such as losing employer health insurance.

What is durable medical equipment in Medicare?

Durable medical equipment (DME) is reusable medical equipment prescribed for home use, such as wheelchairs and walkers, covered at 80% by Medicare Part B.

What does assignment mean in Medicare?

Assignment means a doctor agrees to accept Medicare's approved payment amount as payment in full, so you owe only your cost-share.

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Medicare Glossary: Key Terms Defined | SeniorAffair.com

SeniorAffair.com › Medicare Explained

Medicare Glossary: Key Terms Defined

Plain-language definitions of Medicare terminology for adults 55 and older. Find exactly what a term means — without the government jargon.

Updated May 2026 30 terms defined Medically reviewed

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