Commonly used terms in Medicare coverage

In Medicare, adults eligible for benefits may find that some of the terms used can be overwhelming or confusing.

Below are definitions of commonly used coverage terms from The United States Department of Health and Human Services' Centers for Medicare and Medicaid Services.

• Assignment: An agreement by your doctor, provider or supplier to be paid by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

• Benefit period: The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you're admitted to a hospital or skilled nursing facility and ends when you haven't received any inpatient hospital care for 60 days in a row.

• Claim: Request for payment you submit to Medicare or other health insurance when you get bills for services that you think are covered.

• Coinsurance: An amount you may be required to pay as your share of the cost for services after you pay any deductibles.

• Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply. A copayment is usually a set amount.

• Doughnut hole: A coverage gap in prescription drug plans where you will pay a discounted price on brand-named prescription drugs if you and your drug plan already spent a predetermined amount on drugs.

• 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.

• Lifetime reserve days: Additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.

• Medicare-approved amount: The amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount charged. Medicare pays part of this amount and you're responsible for the difference.

• Premium: The periodic payment to Medicare, an insurance company, or a health-care plan for health or prescription coverage.

For a complete list, visit www.medicare.gov/glossary.