Glossary

Appointed Representative

Beneficiary

Claim

Co-insurance

Co-pay (or co-payment)

Coverage determination

Coverage Gap

Deductible

Generic drug

Medicare Advantage Prescription Drug Plan (MA-PD plan): A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. source: Medicare.gov

Out-of-Pocket Threshold (or Limit)

Over-the-counter (OTC) Drugs

Pharmacy Benefit Management Company (PBM)

Prescription Drug Plan (PDP)

Prior authorization