---
title: Medicare and Medicaid Terminology
description: Explore Medicare and Medicaid terminology, including coverage options, dual eligibility, and cost assistance, for interpreted member services calls.
---
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# Medicare and Medicaid Terminology
## A quick-reference glossary for interpreting conversations about Medicare, Medicaid, dual eligibility, and healthcare cost assistance.
Medicare and Medicaid are different public health coverage programs. Some people qualify for both. The program, plan, and type of eligibility affect benefits, costs, and how services are arranged.
### Programs and Medicare parts
- Medicare: A federal health insurance program primarily for people age 65 or older and certain younger people with qualifying disabilities or conditions, subject to eligibility requirements.
- Medicaid: A joint federal and state program providing health coverage to eligible people under state and federal rules.
- Original Medicare: Medicare coverage consisting of Part A and Part B, with covered services generally paid through the federal fee-for-service program.
- Medicare Part A: Hospital insurance that helps cover inpatient hospital care and certain skilled nursing facility, hospice, and home health services under applicable rules.
- Medicare Part B: Medical insurance that helps cover provider services, outpatient care, durable medical equipment, and many preventive services.
- Medicare Advantage (Part C): A Medicare-approved private health plan offering an alternative way to receive Part A and Part B benefits and usually Part D coverage.
- Medicare Part D: Prescription drug coverage offered through Medicare-approved private plans, either separately or as part of certain Medicare health plans.
- Medicare Supplement Insurance (Medigap): Private insurance that helps pay certain costs remaining under Original Medicare; it is not Medicare Advantage.
### Eligibility and assistance
- Beneficiary: A person entitled to benefits under a program such as Medicare or Medicaid.
- Member: A person enrolled in a particular health plan.
- Dual eligibility: Eligibility for both Medicare and Medicaid; the scope of Medicaid assistance may differ among individuals.
- Full-benefit dual eligibility: Eligibility for Medicare and full Medicaid benefits under applicable state rules.
- Medicare Savings Program: A state-administered program that helps eligible people pay certain Medicare costs.
- Extra Help: A Medicare program helping eligible people with limited income and resources pay Part D costs.
- State Medicaid agency: The state organization responsible for administering Medicaid.
### Coverage arrangements
- Fee-for-service: A payment arrangement in which providers are paid for individual covered services.
- Medicaid managed care: An arrangement in which a state contracts with health plans or other managed care entities to deliver specified Medicaid services.
- Managed care organization (MCO): An organization contracted to arrange or provide a defined set of health services under a managed care arrangement.
- Coordination of benefits: Rules and processes determining how multiple sources of coverage work together.
- Primary payer: The payer responsible for paying first under applicable coordination rules.
- Secondary payer: A payer that considers eligible costs after the primary payer processes a claim.
Medicare and Medicaid eligibility, benefits, payment responsibilities, and assistance programs vary by program, state, plan, and individual circumstances. A Medicare counselor, state Medicaid agency, or plan representative can explain which arrangements apply. Having both programs does not mean every service is automatically covered without cost.
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