Take a coin out of your pocket.... any denomination... with the heads side up. Hold at the top and bottom at 12:00 and 6:00 o'clock positions and flip it over and the reverse design will be right side up. That is "coin aligned".

Now for a "medal design": Holding the coin in the same 12:00 and 6:00 position, if the coin were to be rotated left to right, or right to left, in order for the heads and tails side to be right side up.... this is what is called "medal aligned".