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Medicare Terms & Resources

Get familiar with often-used terms and resources that you will encounter throughout the Medicare process.

Below you will find a guide to help you learn more about Medicare plan types, services, and common insurance terms.

FORMULARY

A list of covered drugs selected by Martin’s Point Generations Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Martin’s Point Generations Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Martin’s Point Generations Advantage network pharmacy, and other plan rules are followed.

WELLNESS WALLET

Fitness/wellness reimbursement benefit offered with all Generations Advantage plans. See each plan’s benefit details for covered services and equipment.

COINSURANCE

When you and your insurance plan share the cost of care based on a percentage. For example, a plan might pay 80% of the cost for a service and you pay the remaining 20%. Percentages vary by plan and service.

COPAYMENT (COPAY)

When you and your insurance plan share costs based on a flat dollar amount that you pay. For example, at an office visit or a pharmacy, you may be asked to pay a $10 or $20 “copay” or other flat fee.

DEDUCTIBLE

The amount you must pay each year for health care or prescriptions before your insurance begins to share costs with you.

NETWORK

A set of health care providers who are contracted to provide health care services to patients with a particular health insurance plan.

OUT-OF-POCKET MAXIMUM

The total amount that you will have to pay “out-of-pocket” each year for copays and coinsurance before your insurance will start paying 100% of these costs for covered services.

NOTE: Monthly premiums and prescription drug costs are not included when figuring out-of-pocket costs.