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.
Premium
The amount you pay to the government or to an insurance company each month/quarter in order to have health or prescription drug coverage.
National Resources
Medicare
1-800-MEDICARE (1-800-633-4227)
(TTY/TDD: 1-877-486-2048)
24 hours a day, 7 days a week
Social Security
1-800-772-1213
(TTY/TDD: 1-800-325-0778)
Maine Resources
Maine State Health Insurance Assistance Program
1-800-262-2232
(TTY/TDD: 1-800-606-0215)
MaineCare (Medicaid)
207-287-2674
(TTY/TDD: 711)
Maine Low Cost Drugs for the Elderly or Disabled Program (DEL)
& Maine Rx Plus
1-866-796-2463
(TTY/TDD: 1-800-423-4331)
New Hampshire Resources
New Hampshire ServiceLink Resource Center Network
1-866-634-9412
New Hampshire Medicaid
1-800-852-3345 ext 4344 or
603-271-4344
.
Next Steps...
Compare Our Plans
We offer a variety of Medicare Advantage plans designed to fit your health care needs and budget.
Explore Provider Network
Is your doctor in our network? We have over 15,000 providers who participate in the Generations Advantage network.
Check Your Medications
Use the Drug Formulary Search Tool to find detailed coverage information for specific medications.
Request a Medicare Guide
This free guide can help answer your questions and give you valuable information about our plans.
Attend a Seminar
Have additional questions? Join us for a free Medicare Advantage plan seminar. To fit your schedule, our sessions are available in-person or online.
Enroll in Generations Advantage
Ready to enroll? Our enrollment process only takes about 10 minutes—have your Medicare card ready and let's get started.
We're here to help guide you.
Local benefit specialists available to help you with your questions or give you personalized assistance.
