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Medicare Common Terms


HERE ARE SOME COMMON TERMS YOU'LL SEE ALONG THE WAY
 
 
 
COINSURANCE
Coinsurance is usually a percentage of the cost for a service that you would pay. For example, if your coinsurance is 20% for covered services, your plan would pay 80% of the covered charges, and you would pay the coinsurance of 20%.

COPAYMENT
A fixed dollar amount you pay at the time you receive a covered service, such as a doctor’s office visit.

COVERAGE GAP (DONUT HOLE)
Most Medicare drug plans have a coverage gap (also called the “donut hole”). This coverage gap begins after you and your drug plan together have spent a certain amount for covered drugs. Not everyone will enter the coverage gap because their drugs costs won’t be high enough.

DEDUCTIBLE
An amount you must pay for covered services within a given year before the insurance company or Medicare begins to pay. For instance, if you have a $500 deductible, you must pay for the first $500 in covered medical expenses before your health plan pays.

EXCESS CHARGES
The amount a provider might charge you over the Medicare-approved amount.

FORMULARY
A list of covered prescription drugs along with their formulas, uses, dosages and methods of preparation.

GUARANTEED ISSUE RIGHTS
Rights you have in certain situations when insurance companies must offer you certain Medicare Supplement (Medigap) plans. In these situations, an insurance company must sell you a Medicare Supplement policy, cover all your pre-existing health conditions and can’t charge you more for a Medicare Supplement policy regardless of past or present health problems.

MEDICARE-APPROVED AMOUNT
This is the amount a health care provider can be paid for a service.

OUT-OF-POCKET MAXIMUM
The most you’ll have to pay for covered services within a certain amount of time (usually one year).

PREMIUM
The fixed amount you pay monthly for coverage. Depending on your health or prescription drug coverage, you may pay your premium to Medicare or a private insurance company.

PRIMARY CARE PHYSICIAN (PCP)
This is the doctor you see first for most health issues. Your PCP may coordinate your care with specialists and other health care providers to ensure you get the care you need to manage your health.
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Last Updated: 10/1/2020
MULTI_PLAN_HM_91545_2021 Accepted 9/28/2020
Attention: This website is operated by Savoy and is not the Health Insurance Marketplace website. In offering this website, Savoy is required to comply with all applicable federal laws, including the standards established under 45 CFR § 155.220(c) and (d) and standards established under 45 CFR § 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov.

Medicare Advantage and Prescription Drug Plans are HMO, PPO, and PDP plans with a Medicare Contract. Enrollment in Medicare Advantage and Prescription Drug Plans depends on the plan's contract renewal with Medicare.

Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. You must continue to pay your Medicare Part B premium.

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Medicare Advantage organizations and/or Medicare Part D plan sponsors comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year.

This is not a complete listing of plans available in your service area. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

ATENCIÓN: Si habla espanol, hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 833.600.6727 (TTY/TDD: 711) 9am - 5pm, Monday - Friday

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This information is available for free in other languages. Please call our customer service number at 833.600.6727 (TTY/TDD: 711) 9am - 5pm, Monday - Friday

A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

Medicare beneficiaries may also enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

Every year, Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

You are not required to provide any health related information unless it will be used to determine enrollment eligibility.

Sales agents/producers may be compensated based on your enrollment in a health plan.

Cost Estimates are based on the information shown under My Information, using data about past experiences by beneficiaries with similar attributes and the premiums and benefits provided by the plan. Actual costs may vary. Monthly medical costs are represented by annual figures divided evenly per month.