Medicare Glossary

Coinsurance

The percentage of costs you pay for a covered health care service after you have paid your deductible. For example, under Original Medicare Part B, you pay 20% of the Medicare-approved amount for most doctor services.

Cost-sharing

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copays — but not premiums.

Medicare Savings Program

State programs that help people with limited income pay Medicare premiums, deductibles, copays, and coinsurance. The four types are QMB, SLMB, QI, and QDWI, each with different income and eligibility thresholds.

Also known as: MSP

Medicare-Approved Amount

The fee Medicare sets for a medical service or item. Doctors who accept Medicare assignment agree to accept this amount as full payment. You pay your share (copay or coinsurance) based on this approved amount, not the doctor's billed charge.

Also known as: Medicare fee schedule amount

Qualified Medicare Beneficiary (QMB)

A Medicare Savings Program for people with the lowest incomes. If you qualify as a QMB, your state pays your Part A and Part B premiums, and providers who accept Medicare cannot charge you copays, coinsurance, or deductibles.

Also known as: QMB