Glossary of Terms

Common Insurance Terms

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.

Generation Advantage Terms

Wellness Wallet: Fitness/wellness reimbursement benefit offered with all Generations Advantage plans. See each plan’s benefit details for covered services and equipment.

Additional Medicare Terms

Click here for a Glossary of Medicare Terms @ Medicare.gov

Medicare Advantage Plan Types

Health Maintenance Organization (HMO): An insurance plan that requires you to use a network of providers. The Generations Advantage Value and Value Plus plans are HMO plans.

Health Maintenance Organization with a Point of Service option (HMO-POS): An HMO plan with flexibility to see out-of- network providers for some covered services. You may pay more if you use out-of-network providers, except in emergency or urgent care situations. The Generations Advantage Prime Plan is an HMO-POS plan.

Preferred Provider Organization (PPO): A type of plan that gives the most flexibility in provider choice. You may use out-of-network providers if they accept our payment. You may pay more if you use out-of-network providers, except in emergency or urgent care situations. The Generations Advantage Select and Flex Plans are PPO plans.

Health Maintenance Organization-Special Needs Plan (HMO-SNP): An HMO with benefits designed to meet the health care needs of individuals with specific chronic conditions. Focus DC is an HMO-SNP plan.

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