Medicare Glossary

Service Area

The geographic area where a Medicare Advantage or Part D plan is available and provides coverage. Plans may have different networks and costs in different parts of their service area. Moving outside a plan's service area may trigger a Special Enrollment Period.

Special Needs Plan (SNP)

A Medicare Advantage plan designed for people with specific diseases, conditions, or characteristics — such as dual eligibles (Medicare and Medicaid), institutionalized beneficiaries, or those with certain chronic conditions like diabetes or heart disease.

Also known as: SNP

Star Ratings

A 1–5 star quality rating system that CMS uses to measure how well Medicare Advantage and Part D plans perform. Ratings are based on measures including member experience, customer service, and managing chronic conditions. Higher-rated plans may receive bonus payments.

Also known as: CMS Star Ratings, Quality ratings

Step Therapy

A coverage requirement where you must try a less expensive drug first before your plan will cover a more expensive one. Commonly used in Medicare Advantage and Part D plans to control costs.

Also known as: Fail first policy

Summary of Benefits

A standardized document that Medicare Advantage and Part D plans must provide that summarizes the plan's costs, covered benefits, and important rules. It is a shorter, easier-to-read version of the Evidence of Coverage.

Supplemental Benefits

Extra benefits offered by Medicare Advantage plans beyond the standard Medicare coverage. Examples include dental, vision, hearing, fitness programs, over-the-counter allowances, and transportation to medical appointments.

Also known as: Extra benefits