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Glossary

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations, and rulings.

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Term	Definition
CARRIER	A private company that has a contract with Medicare to pay your physician and most other Medicare Part B bills.
CATASTROPHIC COVERAGE	Once your total drug costs reach the $5451.25 maximum, you pay a small coinsurance (like 5%) or a small co-payment for covered drug costs until the end of the calendar year.
CERTIFICATE OF CREDITABLE COVERAGE	A written certificate issued by a group health plan or health insurance issuer (including an HMO) that states the period of time you were covered by your health plan
CMS HEARING OFFICER	An individual designated by CMS to conduct the appeals process for a claim dispute
COINSURANCE	The amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Plan, this is a percentage (like 20%) of the Medicare approved amount. You have to pay this amount after you pay the deductible for Part A and/or Part B. In a Medicare Prescription Drug Plan, the coinsurance will vary depending on how much you have spent.
COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF)	A facility that mainly provides rehabilitation services after an illness or injury, and provides a variety of services including physician's services, physical therapy, social or psychological services, and outpatient rehabilitation.
COORDINATION OF BENEFITS	Process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim. Also called cross-over.
COPAYMENT	In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor’s visit, or prescription. A copayment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor’s visit or prescription. Copayments are also used for some hospital outpatient services in the Original Medicare Plan.
CO-PAYMENT	In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor’s visit, or prescription. A copayment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor’s visit or prescription. Co-payments are also used for some hospital outpatient services in the Original Medicare Plan.
COST SHARING	The amount you pay for health care and/or prescriptions. This amount can include copayments, coinsurance, and/or deductibles.
COVERED EMPLOYEE	An individual who is (or was) provided coverage under a group health plan. See also Group Health Plan, Retiree.
CREDIBLE COVERAGE	Health coverage you have had in the past, such as group health plan (including COBRA continuation coverage), an HMO, an individual health insurance policy, Medicare or Medicaid, and this prior coverage was not interrupted by a significant break in coverage. The time period of this prior coverage must be applied toward any pre-existing condition exclusion imposed by a new health plan. Proof of your creditable coverage may be shown by a certificate of creditable coverage or by other documents showing an individual had health coverage, such as a health insurance ID card. See also Certificate of Creditable Coverage.
CREDITABLE COVERAGE	Is health coverage that you had in the past that gives you certain rights when you apply for new coverage.
CREDITABLE COVERAGE (MEDIGAP)	Certain kinds of previous health insurance coverage that can be used to shorten a pre-existing condition waiting period under a Medigap policy. (See pre-existing conditions.)
CREDITABLE PRESCRIPTION DRUG COVERAGE	Prescription drug coverage (like from an employer or union), that pays out, on average, as much as or more than Medicare’s standard prescription drug coverage.
CRITICAL ACCESS HOSPITAL	A small facility that gives limited outpatient and inpatient hospital services to people in rural areas.
CUSTODIAL CARE	Nonskilled, personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include care that most people do themselves, like using eye drops. In most cases, Medicare doesn’t pay for custodial care.

This glossary explains terms in the Medicare program, but it is not a legal document. The official Medicare program provisions are found in the relevant laws, regulations,and rulings.

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