Medicare glossary

Annual Election Period (AEP)

During the AEP, Medicare Advantage-eligible individuals may enroll in or disenroll from an MA plan. The last enrollment request made, determined by the application date, will be the enrollment request that takes effect. AEP occurs from October 15 through December 7 of every year.

Beneficiary

A person who has health care insurance through the Medicare and/or Medicaid program.

Benefit Period

A “benefit period” begins the day you go into a hospital or skilled nursing facility (SNF). The benefit period ends when you haven’t received any hospital care (or skilled care in an SNF) for 60 days in a row. If you go into a hospital or an SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods. 

Carrier

A private insurance company that has a contract with Medicare to pay your physician and other claims inclusive of Part B services

Catastrophic Coverage

Once a beneficiary’s out-of-pocket spending on covered drugs reaches $2,000, they enter catastrophic coverage, which ensures they pay no additional costs for their medications for the rest of the year.

Center for Medicare & Medicaid Services (CMS)

The US federal agency that administers Medicare, Medicaid and the State Children’s Health Insurance Program. 

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.

Coinsurance

The amount you may be required to pay for services after you pay any plan deductibles. In Original Medicare, 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 referred to as “cross-over.”