Medicare Glossary

Copay (Copayment)

A fixed dollar amount you pay for a covered health care service at the time of service. For example, a $20 copay for each doctor's visit. The amount can vary by the type of service and whether you are in-network.

Also known as: Copayment, Fixed cost share

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.

Extra Help

A federal program that helps people with limited income and resources pay Part D prescription drug costs, including premiums, deductibles, and copays. Also called the Low Income Subsidy (LIS).

Also known as: Low Income Subsidy, LIS

Low Income Subsidy (LIS)

See Extra Help. A federal program that reduces Part D costs for people with limited income and resources, covering most premiums, deductibles, and copays.

Also known as: LIS, Extra Help

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