Glossary

The scope, terms and/or condition(s) of coverage including any limitation(s) associated with the plan provision of the service.

The money or services provided by an insurance policy. In a health plan, benefits are the health care you get.

The way that Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go to a hospital or skilled nursing facility. The benefit period ends when you haven’t received any hospital care (or skilled care in a SNF) for 60 days in a row. If you go into the hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins if you are in the Original Medicare Plan. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.

The amounts disbursed for covered services to beneficiaries after the deductible and coinsurance amounts have been deducted.

A letter that is required with CMS Administrator's signature when Medicare
beneficiaries will be contacted to participate in a research project.

A restricted public use file. An Agreement for Release of the Centers for Medicare & Medicaid (CMS) Beneficiary Encrypted Files (PDF, 13KB) data
use agreement is required.

The name for a person who has health care insurance through the Medicare or Medicaid program.

A benchmark is sustained superior performance by a medical care provider, which can be used as a reference to raise the mainstream of care for Medicare beneficiaries. The relative definition of superior will vary form situation to situation. In many instances an appropriate benchmark would be a provider that appears in the top 10% of all providers for more than a year.

Benefits provided in Medigap Plan A. They are also included in all other standardized Medigap policies. (See Medigap Policy.)

Basic Benefits includes both Medicare-covered benefits (except hospice services) and additional benefits.