Medicare Terms & Resources 

Learn more about Medicare plan types, Martin’s Point Generations Advantage 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.

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