Glossary

Annual Election Period (November 15 - December 31 of each year):
This is for anyone wishing to join a Medicare Advantage or Prescription Drug Plan or switch to a different plan. Your coverage will begin on January 1 of the following year.

Co-payment:
The amount you pay out-of-pocket for a doctor's visit or a prescription. A co-payment is usually a set amount. For example, your co-payment could be $10 or $20 for a doctor's visit or prescription.

Drug Tiers:
Drugs listed on a formulary are also organized into drug tiers or groups of different types of drugs. Each tier represents a different cost category. The lowest tier generally offers generic drugs and has the least expensive co-pay.

Emergency Care:
Covered services that are 1) furnished by a provider qualified to furnish emergency services; and 2) needed to evaluate or stabilize an emergency medical condition.

Formulary:
A formulary is a list of the drugs covered by your health plan. You can request a copy of the formulary by calling the customer service department of your plan, or you may view an online version on your plan's website.

Generic Drugs:
A prescription drug that has the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Medicare:
The Federal health insurance program for people 65 years of age or older, some people under age 65 with disabilities, and people with End-Stage Renal Disease (generally those with permanent kidney failure who need dialysis or a kidney transplant).

Medicare Part A (Hospital Insurance):
Helps cover your inpatient care in hospitals. Part A also helps cover skilled nursing facility, hospice, and home health care if you meet certain conditions.

Medicare Part B (Medical Insurance):
Helps cover medically-necessary services like doctors' services and outpatient care. Part B also helps cover some preventative services to help maintain your health and to keep certain illnesses from getting worse.

Medicare Part C (Medicare Advantage Plans):
Medicare Part C is another way to get your Medicare benefits. It combines Part A, Part B, and, sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different co-payments, coinsurance, or deductibles for these services.

Medicare Part D (Medicare Prescription Drug Coverage):
Medicare Part D helps cover your prescription drugs. This coverage may help lower your prescription drug costs and help protect against higher costs in the future.

Network Pharmacy:
A network pharmacy is a pharmacy where members of our Plan can receive covered prescription drug benefits. We call them "network pharmacies" because they contract with our Plan. In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies.

Open Enrollment Period (Not applicable to PDP) January 1 - March 31 of each year:
During this period, anyone already enrolled in a Medicare Advantage Plan can switch to a different Medicare Advantage Plan with similar drug coverage. Anyone with original Medicare and a Prescription Drug Plan can switch to a Medicare Advantage Plan with similar drug plan.

Original Medicare Plan:
The Original Medicare Plan has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). It is a fee-for-service health plan. You must pay the deductible. Medicare pays its share of the Medicare approved amount, and you pay your share (coinsurance and deductibles).

Primary Care Physician (PCP):
A healthcare professional who is trained to give you basic care. Your PCP is responsible for providing or authorizing covered services while you are a plan member.

Referral:
Your PCP's approval for you to see a certain plan specialist or to receive certain covered services from plan providers.

Special Election Period:
Anyone who is new to Medicare, qualifies for extra help or moves in/out of the plan's service area may join or switch Medicare Advantage plans; Other circumstances may also qualify as a Special Election Period