 CMS |
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| Acronym for the Centers for Medicare & Medicaid Services, the federal government agency that administers the Medicare program and works with states to manage the Medicaid program. |
| Co Insurance |
| A type of cost-sharing arrangement where Medicare beneficiaries pay a percentage of the approved amount for a covered health service. |
| Co Payment |
| The amount that someone must pay out-of -pocket when they receive some health services or purchase prescription drugs covered through Medicare. Co-payments are stated as flat dollar amounts and vary according to the type of service provided. |
| Coverage Gap (a.k.a., "Doughnut Hole" or "Donut Hole") |
| The term given to the coverage gap in Medicare Part D between $2,250 and $5,100 of total prescription drug expenses that requires beneficiaries to pay up to $2,850 ($5,100 - $2,250) of their drug costs. Above the $5,100 stop-loss limit is considered catastrophic coverage. At this point, Medicare beneficiaries would have spent $3,600 out -of -pocket on prescription drugs (between the Part D deductible, coinsurance, and uncovered drug costs in the doughnut hole) and would then be responsible for paying the greater of a $2 co-payment for generics and $5 for brand drugs or 5% coinsurance. |
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| Recommended Links: CMS Medicare |
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