FAQ-Page
Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.
Source: Medicare and You 2027 Medicare Handbook
A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.
Source: Medicare and You 2027 Medicare Handbook
An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.
Source: Medicare and You 2027 Medicare Handbook
A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.
Source: Medicare and You 2027 Medicare Handbook
A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.
Source: Medicare and You 2027 Medicare Handbook
The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.
Source: Medicare and You 2027 Medicare Handbook
Health care to prevent illness or detect illness at an early stage, when treatment
is likely to work best (for example, preventive services include Pap tests, flu
vaccines, and screening mammograms).
Source: Medicare and You 2027 Medicare Handbook
The periodic payment to Medicare, an insurance company, or a health care plan
for health or prescription drug coverage.
Source: Medicare and You 2027 Medicare Handbook
A Fee-for-Service health insurance program that has 2 parts: Part A (Hospital
Insurance) and Part B (Medical Insurance). You typically pay a portion of the
costs for covered services as you get them. Under Original Medicare, you don’t
have coverage through a Medicare Advantage Plan or another type of Medicare
health plan.
Source: Medicare and You 2027 Medicare Handbook
Medicare Supplement Insurance sold by private insurance companies to fill
“gaps” in Original Medicare coverage.
Source: Medicare and You 2027 Medicare Handbook
Plans offered by private companies that contract with Medicare to provide Part
A, Part B, and in many cases, Part D benefits. Includes Medicare Advantage
Plans and certain other types of coverage (like Medicare Cost Plans, PACE
programs, and demonstrations/pilot programs).
Source: Medicare and You 2027 Medicare Handbook
The payment amount that Original Medicare sets for a covered service or item.
Medicare pays its share and you pay your share of that amount.
Source: Medicare and You 2027 Medicare Handbook
A type of Medicare health plan offered by a private company that contracts
with Medicare. Medicare Advantage Plans provide all of your Part A and Part B
benefits, with a few exclusions, for example, certain aspects of clinical trials
which are covered by Original Medicare even though you’re still in the plan.
Medicare Advantage Plans include:
• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medical Savings Account Plans
If you’re enrolled in a Medicare Advantage Plan:
• Most Medicare services are covered through the plan
• Most Medicare services aren’t paid for by Original Medicare
• Most Medicare Advantage Plans offer prescription drug coverage
Source: Medicare and You 2027 Medicare Handbook
Health care services or supplies needed to diagnose or treat an illness, injury,
condition, disease, or its symptoms and that meet accepted standards of
medicine.
Source: Medicare and You 2027 Medicare Handbook
A joint federal and state program that helps with medical costs for some people
with limited income and (in some cases) resources. Medicaid programs vary
from state to state, but most health care costs are covered if you qualify for
both Medicare and Medicaid.
Source: Medicare and You 2027 Medicare Handbook
Acute care hospitals that provide treatment for patients who stay, on average,
more than 25 days. Most patients are transferred from an intensive or critical
care unit.
Source: Medicare and You 2027 Medicare Handbook
In Original Medicare, these are additional days that Medicare will pay for when
you’re in a hospital for more than 90 days. You have a total of 60 reserve days
that can be used during your lifetime. For each lifetime reserve day, Medicare
pays all covered costs except for a daily coinsurance.
Source: Medicare and You 2027 Medicare Handbook
A hospital, or part of a hospital, that provides an intensive rehabilitation
program to inpatients.
Source: Medicare and You 2027 Medicare Handbook
A list of prescription drugs covered by a prescription drug plan or another
insurance plan offering prescription drug benefits. Also called a drug list.
Source: Medicare and You 2027 Medicare Handbook
A Medicare program to help people with limited income and resources pay
Medicare prescription drug program costs, like premiums, deductibles, and
coinsurance.
Source: Medicare and You 2027 Medicare Handbook
This is an electronic way for your prescriber (your doctor or other health care
provider who’s legally allowed to write prescriptions) to send your prescriptions
directly to your pharmacy. Electronic prescribing can save you money and time,
and help keep you safe.
Source: Medicare and You 2027 Medicare Handbook
Electronic health records are a history of your medical conditions, health care,
and treatment that your doctor, other health care provider, medical office staff,
or hospital keeps on a computer.
• They can help lower the chances of medical errors, eliminate duplicate tests,
and may improve your overall quality of care.
• Your doctor’s electronic health records may be able to link to a hospital, lab,
pharmacy, other doctors, or immunization information systems (registries), so
the people who care for you can have a more complete picture of your health.
Source: Medicare and You 2027 Medicare Handbook
The amount you must pay for health care or prescriptions before Original
Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your
other insurance begins to pay.
Source: Medicare and You 2027 Medicare Handbook
A small facility located in a rural area more than 35 miles (or 15 miles if in mountainous terrain or in areas with only secondary roads) from another hospital or critical access hospital. This facility provides 24/7 emergency care, has 25 or fewer inpatient beds, and maintains an average length of stay of 96 hours or less for acute care patients.
Source: Medicare and You 2027 Medicare Handbook
Prescription drug coverage that’s expected to pay, on average, at least as much as Medicare drug coverage. This could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance coverage.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Source: Medicare and You 2027 Medicare Handbook
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Source: Medicare and You 2027 Medicare Handbook
Groups of doctors, hospitals, and other health care providers that accept Original Medicare and work together to give patients high-quality, coordinated health care that are accountable for the quality and cost of care they provide you.
Source: Medicare and You 2027 Medicare Handbook
Click a topic to expand to see all related FAQs.
01 General
Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.
Source: Medicare and You 2027 Medicare Handbook
A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.
Source: Medicare and You 2027 Medicare Handbook
An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.
Source: Medicare and You 2027 Medicare Handbook
A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.
Source: Medicare and You 2027 Medicare Handbook
A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.
Source: Medicare and You 2027 Medicare Handbook
The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Source: Medicare and You 2027 Medicare Handbook
02 Medicare
Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.
Source: Medicare and You 2027 Medicare Handbook
A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.
Source: Medicare and You 2027 Medicare Handbook
An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.
Source: Medicare and You 2027 Medicare Handbook
A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.
Source: Medicare and You 2027 Medicare Handbook
A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.
Source: Medicare and You 2027 Medicare Handbook
The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.
Source: Medicare and You 2027 Medicare Handbook
Health care to prevent illness or detect illness at an early stage, when treatment
is likely to work best (for example, preventive services include Pap tests, flu
vaccines, and screening mammograms).
Source: Medicare and You 2027 Medicare Handbook
The periodic payment to Medicare, an insurance company, or a health care plan
for health or prescription drug coverage.
Source: Medicare and You 2027 Medicare Handbook
A Fee-for-Service health insurance program that has 2 parts: Part A (Hospital
Insurance) and Part B (Medical Insurance). You typically pay a portion of the
costs for covered services as you get them. Under Original Medicare, you don’t
have coverage through a Medicare Advantage Plan or another type of Medicare
health plan.
Source: Medicare and You 2027 Medicare Handbook
Medicare Supplement Insurance sold by private insurance companies to fill
“gaps” in Original Medicare coverage.
Source: Medicare and You 2027 Medicare Handbook
Plans offered by private companies that contract with Medicare to provide Part
A, Part B, and in many cases, Part D benefits. Includes Medicare Advantage
Plans and certain other types of coverage (like Medicare Cost Plans, PACE
programs, and demonstrations/pilot programs).
Source: Medicare and You 2027 Medicare Handbook
The payment amount that Original Medicare sets for a covered service or item.
Medicare pays its share and you pay your share of that amount.
Source: Medicare and You 2027 Medicare Handbook
A type of Medicare health plan offered by a private company that contracts
with Medicare. Medicare Advantage Plans provide all of your Part A and Part B
benefits, with a few exclusions, for example, certain aspects of clinical trials
which are covered by Original Medicare even though you’re still in the plan.
Medicare Advantage Plans include:
• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medical Savings Account Plans
If you’re enrolled in a Medicare Advantage Plan:
• Most Medicare services are covered through the plan
• Most Medicare services aren’t paid for by Original Medicare
• Most Medicare Advantage Plans offer prescription drug coverage
Source: Medicare and You 2027 Medicare Handbook
Health care services or supplies needed to diagnose or treat an illness, injury,
condition, disease, or its symptoms and that meet accepted standards of
medicine.
Source: Medicare and You 2027 Medicare Handbook
A joint federal and state program that helps with medical costs for some people
with limited income and (in some cases) resources. Medicaid programs vary
from state to state, but most health care costs are covered if you qualify for
both Medicare and Medicaid.
Source: Medicare and You 2027 Medicare Handbook
Acute care hospitals that provide treatment for patients who stay, on average,
more than 25 days. Most patients are transferred from an intensive or critical
care unit.
Source: Medicare and You 2027 Medicare Handbook
In Original Medicare, these are additional days that Medicare will pay for when
you’re in a hospital for more than 90 days. You have a total of 60 reserve days
that can be used during your lifetime. For each lifetime reserve day, Medicare
pays all covered costs except for a daily coinsurance.
Source: Medicare and You 2027 Medicare Handbook
A hospital, or part of a hospital, that provides an intensive rehabilitation
program to inpatients.
Source: Medicare and You 2027 Medicare Handbook
A list of prescription drugs covered by a prescription drug plan or another
insurance plan offering prescription drug benefits. Also called a drug list.
Source: Medicare and You 2027 Medicare Handbook
A Medicare program to help people with limited income and resources pay
Medicare prescription drug program costs, like premiums, deductibles, and
coinsurance.
Source: Medicare and You 2027 Medicare Handbook
This is an electronic way for your prescriber (your doctor or other health care
provider who’s legally allowed to write prescriptions) to send your prescriptions
directly to your pharmacy. Electronic prescribing can save you money and time,
and help keep you safe.
Source: Medicare and You 2027 Medicare Handbook
Electronic health records are a history of your medical conditions, health care,
and treatment that your doctor, other health care provider, medical office staff,
or hospital keeps on a computer.
• They can help lower the chances of medical errors, eliminate duplicate tests,
and may improve your overall quality of care.
• Your doctor’s electronic health records may be able to link to a hospital, lab,
pharmacy, other doctors, or immunization information systems (registries), so
the people who care for you can have a more complete picture of your health.
Source: Medicare and You 2027 Medicare Handbook
The amount you must pay for health care or prescriptions before Original
Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your
other insurance begins to pay.
Source: Medicare and You 2027 Medicare Handbook
A small facility located in a rural area more than 35 miles (or 15 miles if in mountainous terrain or in areas with only secondary roads) from another hospital or critical access hospital. This facility provides 24/7 emergency care, has 25 or fewer inpatient beds, and maintains an average length of stay of 96 hours or less for acute care patients.
Source: Medicare and You 2027 Medicare Handbook
Prescription drug coverage that’s expected to pay, on average, at least as much as Medicare drug coverage. This could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance coverage.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Source: Medicare and You 2027 Medicare Handbook
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Source: Medicare and You 2027 Medicare Handbook
Groups of doctors, hospitals, and other health care providers that accept Original Medicare and work together to give patients high-quality, coordinated health care that are accountable for the quality and cost of care they provide you.
Source: Medicare and You 2027 Medicare Handbook
03 Affordable Care Marketplace
Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.
Source: Medicare and You 2027 Medicare Handbook
A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.
Source: Medicare and You 2027 Medicare Handbook
An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.
Source: Medicare and You 2027 Medicare Handbook
A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.
Source: Medicare and You 2027 Medicare Handbook
A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.
Source: Medicare and You 2027 Medicare Handbook
The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Source: Medicare and You 2027 Medicare Handbook
FAQ-Page
Skilled nursing care and therapy services provided on a daily basis in a skilled
nursing facility. Examples of skilled nursing facility care include physical therapy
or intravenous injections that can only be given by a physical therapist or a
registered nurse.
Source: Medicare and You 2027 Medicare Handbook
A nursing facility with the staff and equipment to give skilled nursing care and,
in most cases, skilled rehabilitative services and other related health services.
Source: Medicare and You 2027 Medicare Handbook
An area you must live in for the plan to accept you as a member. For plans that
limit which doctors and hospitals you may use, it’s also generally the area where
you can get routine (non-emergency) services. Plans can, and in some cases
must, disenroll you if you move outside their service area.
Source: Medicare and You 2027 Medicare Handbook
A facility that provides emergency department service, observation care, and
certain other specified outpatient medical and health services to patients that
generally stay less than 24 hours.
Source: Medicare and You 2027 Medicare Handbook
A written order from your primary care doctor for you to visit a specialist or get
certain medical services. Without a referral, your plan may not pay for services
from a specialist.
Source: Medicare and You 2027 Medicare Handbook
The doctor you go to first for most health problems. They may talk with other
doctors and health care providers about your care and refer you to them.
Source: Medicare and You 2027 Medicare Handbook
Health care to prevent illness or detect illness at an early stage, when treatment
is likely to work best (for example, preventive services include Pap tests, flu
vaccines, and screening mammograms).
Source: Medicare and You 2027 Medicare Handbook
The periodic payment to Medicare, an insurance company, or a health care plan
for health or prescription drug coverage.
Source: Medicare and You 2027 Medicare Handbook
A Fee-for-Service health insurance program that has 2 parts: Part A (Hospital
Insurance) and Part B (Medical Insurance). You typically pay a portion of the
costs for covered services as you get them. Under Original Medicare, you don’t
have coverage through a Medicare Advantage Plan or another type of Medicare
health plan.
Source: Medicare and You 2027 Medicare Handbook
Medicare Supplement Insurance sold by private insurance companies to fill
“gaps” in Original Medicare coverage.
Source: Medicare and You 2027 Medicare Handbook
Plans offered by private companies that contract with Medicare to provide Part
A, Part B, and in many cases, Part D benefits. Includes Medicare Advantage
Plans and certain other types of coverage (like Medicare Cost Plans, PACE
programs, and demonstrations/pilot programs).
Source: Medicare and You 2027 Medicare Handbook
The payment amount that Original Medicare sets for a covered service or item.
Medicare pays its share and you pay your share of that amount.
Source: Medicare and You 2027 Medicare Handbook
A type of Medicare health plan offered by a private company that contracts
with Medicare. Medicare Advantage Plans provide all of your Part A and Part B
benefits, with a few exclusions, for example, certain aspects of clinical trials
which are covered by Original Medicare even though you’re still in the plan.
Medicare Advantage Plans include:
• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medical Savings Account Plans
If you’re enrolled in a Medicare Advantage Plan:
• Most Medicare services are covered through the plan
• Most Medicare services aren’t paid for by Original Medicare
• Most Medicare Advantage Plans offer prescription drug coverage
Source: Medicare and You 2027 Medicare Handbook
Health care services or supplies needed to diagnose or treat an illness, injury,
condition, disease, or its symptoms and that meet accepted standards of
medicine.
Source: Medicare and You 2027 Medicare Handbook
A joint federal and state program that helps with medical costs for some people
with limited income and (in some cases) resources. Medicaid programs vary
from state to state, but most health care costs are covered if you qualify for
both Medicare and Medicaid.
Source: Medicare and You 2027 Medicare Handbook
Acute care hospitals that provide treatment for patients who stay, on average,
more than 25 days. Most patients are transferred from an intensive or critical
care unit.
Source: Medicare and You 2027 Medicare Handbook
In Original Medicare, these are additional days that Medicare will pay for when
you’re in a hospital for more than 90 days. You have a total of 60 reserve days
that can be used during your lifetime. For each lifetime reserve day, Medicare
pays all covered costs except for a daily coinsurance.
Source: Medicare and You 2027 Medicare Handbook
A hospital, or part of a hospital, that provides an intensive rehabilitation
program to inpatients.
Source: Medicare and You 2027 Medicare Handbook
A list of prescription drugs covered by a prescription drug plan or another
insurance plan offering prescription drug benefits. Also called a drug list.
Source: Medicare and You 2027 Medicare Handbook
A Medicare program to help people with limited income and resources pay
Medicare prescription drug program costs, like premiums, deductibles, and
coinsurance.
Source: Medicare and You 2027 Medicare Handbook
This is an electronic way for your prescriber (your doctor or other health care
provider who’s legally allowed to write prescriptions) to send your prescriptions
directly to your pharmacy. Electronic prescribing can save you money and time,
and help keep you safe.
Source: Medicare and You 2027 Medicare Handbook
Electronic health records are a history of your medical conditions, health care,
and treatment that your doctor, other health care provider, medical office staff,
or hospital keeps on a computer.
• They can help lower the chances of medical errors, eliminate duplicate tests,
and may improve your overall quality of care.
• Your doctor’s electronic health records may be able to link to a hospital, lab,
pharmacy, other doctors, or immunization information systems (registries), so
the people who care for you can have a more complete picture of your health.
Source: Medicare and You 2027 Medicare Handbook
The amount you must pay for health care or prescriptions before Original
Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your
other insurance begins to pay.
Source: Medicare and You 2027 Medicare Handbook
A small facility located in a rural area more than 35 miles (or 15 miles if in mountainous terrain or in areas with only secondary roads) from another hospital or critical access hospital. This facility provides 24/7 emergency care, has 25 or fewer inpatient beds, and maintains an average length of stay of 96 hours or less for acute care patients.
Source: Medicare and You 2027 Medicare Handbook
Prescription drug coverage that’s expected to pay, on average, at least as much as Medicare drug coverage. This could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance coverage.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. A copayment is a fixed amount, like $30.
Source: Medicare and You 2027 Medicare Handbook
An amount you may be required to pay as your share of the cost for benefits after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Source: Medicare and You 2027 Medicare Handbook
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
Source: Medicare and You 2027 Medicare Handbook
Groups of doctors, hospitals, and other health care providers that accept Original Medicare and work together to give patients high-quality, coordinated health care that are accountable for the quality and cost of care they provide you.
Source: Medicare and You 2027 Medicare Handbook
