Glossary

Coinsurance is a percentage of the cost of a covered service that you must pay.

Cost-sharing refers to any contribution members make towards the cost of their healthcare, as defined in their health insurance policy.

Copayments are fixed dollar amounts for covered services. You usually pay this amount at the time you receive care, such as when you go to a primary doctor's office.

Deductible is a fixed dollar amount. This amount must be paid before the plan pays benefits for the year.

Formulary is a list of covered drugs that the plan will pay for. All Medicare prescription drug coverage plans have formularies. Our formulary contains a wide range of generic and brand name drugs that have been approved by the U.S. Food and Drug Administration (FDA). Your doctor can help you save more money by selecting generic drugs from our formulary. All generic drugs are on our formulary unless they're excluded by Medicare. Drugs on our formulary can be purchased from participating retail pharmacies or through mail order.

Medicare Part A (Hospital) provides basic protection that typically pays for your inpatient hospital expenses.

Medicare Part B (Medical) is a voluntary medical insurance program for which enrollees must pay monthly premiums. It provides medical insurance coverage for services such as physician's services, outpatient services, and home health care.

Medicare Part D (Prescriptions) is the prescription drug benefit program created through the U.S. Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The "D" stands for "drugs."

Non-Preferred Brand Name Drug , or non-formulary drug, is a covered medication that has a higher copayment. It has been chosen because the drug is the same but more expensive than others on the formulary.

Original Medicare is the federally-funded national health insurance program in the United States for people over 65 years of age or who meet other criteria. The program is divided into parts (Part A and Part B).

Over-the-counter (OTC) drug is a drug for which a prescription is not needed.

Podiatry is the branch of medicine that deals with the diagnosis, treatment, and prevention of diseases of the human foot. Also called chiropody.

Preferred Brand Name Drug (or formulary brand name drug) is a brand name drug that's included in the plan formulary. It's chosen for your formulary because it's been proven to be safe, effective, and less expensive than other name brands.

Premium is a periodic payment to Medicare, an insurance company, or a health care plan for healthcare or prescription drug coverage.

Specialty Drug is usually a self-injectable medication. It is dispensed by specialty pharmacies.