Senior Care & Medicare Glossary
A complete reference of key terms, concepts, and industry jargon to help you understand estimates, quotes, and contracts. 33 terms defined in plain English.
A
- Adult Day Care
- A community-based program providing supervised daytime activities, health monitoring, and social engagement for older adults, typically costing $80–$120/day with limited Medicare coverage.
- Assisted Living
- A residential care setting providing personal care assistance, meals, and activities for older adults who need help with daily living tasks but do not require 24-hour skilled nursing care.
- Asset Transfer Lookback Period
- The 5-year (60-month) window before a Medicaid long-term care application during which asset transfers below fair market value can trigger a penalty period of ineligibility.
- Advance Directive
- A legal document expressing a person's wishes regarding medical treatment if they become incapacitated, encompassing a living will and/or a healthcare power of attorney.
C
- Coinsurance
- The percentage of costs a Medicare beneficiary shares with Medicare after meeting the deductible; Part B standard coinsurance is 20% of the Medicare-approved amount with no dollar cap.
- Coverage Gap Discount
- A manufacturer discount of 70% on brand-name drugs while a Part D beneficiary is in the coverage gap phase; counts toward the beneficiary's true out-of-pocket (TrOOP) spending.
- Catastrophic Coverage
- The final phase of Medicare Part D coverage where beneficiary cost-sharing drops to zero (2025+) or a small coinsurance after reaching the annual out-of-pocket threshold.
- Care Coordinator
- A healthcare professional — typically a registered nurse or social worker — who organizes and integrates all aspects of a patient's medical care across providers, settings, and transitions.
D
- Deductible
- The amount a Medicare beneficiary must pay out-of-pocket before Medicare begins paying its share; Part A and Part B have separate deductibles that reset on different schedules.
- Donut Hole
- The coverage gap phase in Medicare Part D where, historically, the beneficiary paid a higher percentage of drug costs; largely eliminated for 2025 by the Inflation Reduction Act's $2,000 annual cap.
- DNR
- Do Not Resuscitate — a physician order instructing medical personnel not to perform CPR if a patient's heart stops or they stop breathing.
E
- Enrollment Periods
- Specific windows during which Medicare beneficiaries can sign up for or change Medicare coverage, with late-enrollment penalties applied when eligible individuals miss their Initial Enrollment Period.
G
- Geriatric Care Manager
- A private-pay professional (typically an RN or social worker with gerontology training) hired directly by families to assess, plan, and oversee care for an aging relative, especially at a distance.
H
- Home Health Care
- Medicare-covered intermittent skilled nursing or therapy services delivered in a patient's home when the patient is homebound and a physician certifies medical necessity.
- Hospice
- A Medicare-covered benefit providing comfort-focused care for terminally ill patients with a life expectancy of 6 months or less, including nursing, medications, counseling, and respite care.
L
- Long-Term Care Insurance
- A private insurance product that pays a daily or monthly benefit when the policyholder needs assistance with activities of daily living or has a cognitive impairment, covering home care, assisted living, or nursing home costs.
M
- Medicare Part A
- Hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services; premium-free for most Americans who worked 40+ quarters.
- Medicare Part B
- Medical insurance covering outpatient services, physician visits, preventive care, durable medical equipment, and some home health services; requires a monthly premium paid by the beneficiary.
- Medicare Advantage (Part C)
- An alternative to Original Medicare in which private insurers administer Medicare benefits, typically offering lower premiums, added benefits (dental, vision, hearing), and network restrictions.
- Medicare Part D
- Prescription drug coverage offered through private insurers under Medicare, providing a formulary of covered medications at varying copays and subject to a coverage gap phase.
- Medigap Supplement
- A private insurance policy that pays some or all of the cost-sharing gaps in Original Medicare — deductibles, coinsurance, and copays — with standardized plan letters A through N.
- Memory Care
- A specialized form of residential care for individuals with Alzheimer's disease or other dementias, featuring secured environments, structured programming, and staff trained in dementia care.
- Medicaid Spend-Down
- The process by which an individual reduces countable assets to below a state's Medicaid eligibility threshold — typically $2,000 — in order to qualify for long-term care coverage.
- Medicaid Planning
- Legal strategies used to restructure assets and income to qualify for Medicaid long-term care benefits while preserving wealth for a spouse or heirs within the rules of applicable state and federal law.
O
- Original Medicare
- The traditional fee-for-service Medicare program administered directly by the federal government under Parts A and B, with no network restrictions but no built-in cap on out-of-pocket costs.
- Out-of-Pocket Maximum
- The annual cap on a beneficiary's cost-sharing; Original Medicare has no out-of-pocket maximum, while Medicare Advantage plans must cap in-network costs at $8,850 or less in 2024.
P
- Premium
- The monthly amount a Medicare beneficiary pays for coverage, separate from deductibles and cost-sharing; Part B premiums are income-adjusted under IRMAA for higher earners.
- PACE Program
- Program of All-inclusive Care for the Elderly — a comprehensive managed care program for dual-eligible Medicare/Medicaid seniors that integrates all medical and long-term care services through a single provider.
- Prior Authorization
- A Medicare Advantage or Part D requirement that a physician obtain plan approval before certain services, procedures, or medications are covered, adding administrative steps and potential delays to care.
- POLST
- Physician Orders for Life-Sustaining Treatment — a portable, actionable medical order (not merely an advance directive) that travels with a seriously ill patient across care settings.
R
- Reverse Mortgage
- A loan available to homeowners 62+ that converts home equity into tax-free cash without monthly payments, repaid when the home is sold or the borrower moves or dies.
S
- Skilled Nursing Facility
- A licensed facility providing 24-hour skilled nursing and rehabilitation services for patients recovering from hospitalization; Medicare covers up to 100 days per benefit period following a qualifying 3-day inpatient hospital stay.
- Step Therapy
- A cost management practice where Medicare Part D or Medicare Advantage plans require patients to try lower-cost drug alternatives before approving coverage of a more expensive prescribed medication.
33 terms · Updated April 2026