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.

Deductible

The amount you must pay out of pocket for covered health care services before your insurance begins to pay. Medicare Part A and Part B each have separate deductibles. Many Medicare Advantage plans have their own deductibles.

IRMAA (Income-Related Monthly Adjustment Amount)

An extra amount added to your Part B and Part D premiums if your income is above a certain threshold, based on the tax return from two years earlier. IRMAA is reassessed annually and can be appealed after certain life-changing events like retirement.

Also known as: IRMAA

Premium

The amount you pay for your Medicare coverage, typically deducted monthly. Part A is premium-free for most people. Part B has a standard monthly premium (adjusted for income). Medicare Advantage and Part D plans have their own premiums in addition to Part B.

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

Qualifying Individual (QI)

A Medicare Savings Program that helps pay Part B premiums for people with slightly higher income than SLMB allows. Funding is limited each year and applications are approved on a first-come, first-served basis.

Also known as: QI Program

Specified Low-Income Medicare Beneficiary (SLMB)

A Medicare Savings Program that helps pay Part B premiums for people with income modestly above the Qualified Medicare Beneficiary (QMB) limit.

Also known as: SLMB