MarketplaceMaryland Health Connection is a marketplace for consumers and small business owners to compare, shop and enroll in health coverage.
Maryland Children’s Health Program (MCHP)(MCHP)Low-income children may qualify for free or low-cost health coverage through MCHP, available through Maryland Health Connection.
Maryland Health Insurance Program (MHIP)(MHIP)MHIP is the public insurance plan available to individuals who have not been able to qualify for insurance based on a pre-existing condition.
MedicaidMedicaid is federal government program run by the individual states. It's designed to provide assistance to people who can't afford skilled or custodial…
Medicaid/Medical AssistanceA joint federal-state health insurance program that is run by the states and covers certain low-income people (especially children and pregnant women)…
Medical Loss Ratio (MLR)(MLR)A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees.
Medical UnderwritingA process used by insurance companies to try to figure out your health status when you're applying for health insurance coverage to determine whether to…
Medically NecessaryA drug, device, procedure, treatment plan, or other therapy that is covered under your health insurance policy and that your doctor, hospital, or provider…
MedicareMedicare is a federal government insurance program designed to provide healthcare coverage for people 65 or older, certain disabled people, and people…
Medicare AdvantageAn option Medicare beneficiaries can choose to receive most or all of their Medicare benefits through a private insurance company.
Medicare Advantage (Medicare Part C)A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits.
Medicare Cost PlansMedicare cost plans are a type of HMO that contracts as a Medicare Health Plan.
Medicare Hospital Insurance TaxA tax under the Federal Insurance Contributions Act (FICA) that is a United States payroll tax imposed by the Federal government on both employees and…
Medicare Part DA program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage.
Medicare Select PlansA type of Medigap policy that may require the Medicare Beneficiary to use hospitals and, in some cases, doctors within its network to be eligible for full…
Medicare Supplement (Medigap) InsurancePrivate insurance policies that can be purchased to "fill-in the gaps" and pay for certain out-of-pocket expenses (like deductibles and coinsurance) not…
Member Survey ResultsA survey conducted by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) which asks health plan members to rate the care their…
Metal LevelA metal level, also known as a benefit level, is a group of plans that have similar value. Plan levels include bronze, silver, gold and platinum.
Minimum Essential CoverageThe type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act.
Minimum valueA health plan meets this standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population.
Minnesota Comprehensive Health Association (MCHA)(MCHA)The Minnesota Comprehensive Health Association (MCHA) offers policies of individual health insurance to Minnesota residents who have been turned down for…
MinnesotaCareMinnesotaCare is a subsidized health care coverage program for lower income Minnesotans who do not have access to affordable employer-based health care…
Modified Adjusted Gross Income (MAGI)(MAGI)Your modified adjusted gross income (MAGI) is your adjusted gross income (AGI) plus deductions, such as college loan interest and contributions to a…
Multi-Employer PlanIn general, a group health plan that's sponsored jointly by 2 or more employers.
Multi-state planA plan, created by the ACA and overseen by the U.S. Office of Personnel Management (OPM), that will be available in every state through that state's…
Name-brand DrugA drug sold under a name-brand, and covered by original patents (for example, the name brand for hydrocodone is "Vicodin®").
navigatorAn individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options…
NavigatorsNavigators deliver in-person outreach, education, and enrollment in both qualified health plans and public insurance options.
Net Capital GainsThe amount by which your total long-term capital gain for the year is more than your short-term capital loss for the year.
Net Rental IncomeThe amount someone pays you to use your property, after you subtract the expenses you have for the property.
NetworkThe facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
Network PlanA health plan that contracts with doctors, hospitals, pharmacies, and other health care providers to provide members of the plan with services and…
New PlanAs used in connection with the Affordable Care Act: A health plan that is not a grandfathered health plan and therefore subject to all of the reforms in…
Non-Preferred ProviderA provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider.
NondiscriminationA requirement that job-based coverage not discriminate based on health status. Coverage under job-based plans cannot be denied or restricted.
Not Yet Accredited (Health Plan)A plan that hasn't been given a "seal of approval" by an independent company to show it meets national quality standards for health plans.
NoticeNotice refers to two requirements. A copy of the LCA Form ETA 9035 must be given to each H-1B worker.
Open EnrollmentThe time (usually a preset two-week or one-month period annually) when you can change health plans under your employer's group plan.
Open Enrollment PeriodThe period of time during which individuals who are eligible to enroll in a Qualified Health Plan can enroll in a plan in the Marketplace.
Original MedicareOriginal Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Part A (Hospital Insurance)…
Out-of-Network Co-InsuranceThe percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance…
Out-of-Network Co-PaymentA fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan.
Out-of-Network CoinsuranceThe percentage (for example, 40%) you pay of the allowed amount for covered health care services to providers who don't contract with your health…
Out-of-Network CopaymentA fixed amount (for example, $30) you pay for covered health care services from providers who don't contract with your health insurance or plan.
Out-of-network providerFor health plans that utilize an HMO or PPO, a health care provider (such as a hospital or doctor) that is not contracted to be part of the HMO or PPO…
Out-of-PocketThe amount of money you pay for medical services after insurance has paid its contribution.
Out-of-Pocket CostsYour expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered…
Out-of-Pocket EstimateAn estimate of the amount that you may have to pay on your own for health care or prescription drug costs.
Out-of-Pocket LimitThe most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount.
Out-of-Pocket MaximumThe most you will have to pay in a year for deductibles and coinsurance for covered benefits.
Out-of-pocket maximum/limitThe most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits.
Over-the-Counter DrugYou don't need a prescription to obtain over-the-counter drugs.
Patient Protection and Affordable Care Act (PPACA)(PPACA)Legislation (Public Law 111-148) signed by President Obama on March 23, 2010. One of two laws collectively referred to as the Affordable Care Act or…
Patient-Centered Outcomes ResearchResearch that compares different medical treatments and interventions to provide evidence on which strategies are most effective in different populations…
Payment BundlingA payment structure in which different health care providers who are treating you for the same or related conditions are paid an overall sum for taking…
Payment FrequencyYou can choose how often you would like to pay your insurance premiums. If you choose “monthly,” your premium payments will be due every month.
Pension (Retirement Benefit)A payment or series of payments made to you after you retire from work. Generally, the amount of your income from a pension or retirement account…
Physician ServicesHealth care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
PlanA benefit your employer, union or other group sponsor provides to you to pay for your health care services.
Plan YearA 12-month period of benefits coverage under a group health plan. This 12-month period may not be the same as the calendar year.
Point of Service (POS) Plans(POS)A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.
Point-of-Service Plan (POS)A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), in which…
PolicyThe contract form issued by the company to explain the coverage provided. It is a legal document.
Policy YearA 12-month period of benefits coverage under an individual health insurance plan. This 12-month period may not be the same as the calendar year.
PortabilityPortability is a provision of the INA intended to preserve the legal status of an H-1B worker who is already in the U.S.
Pre-authorizationSome insurance companies require authorization from them before they will pay for medical services like hospitalization or surgery.
Pre-existing ConditionA pre-existing condition is a health problem that you already have when you apply for insurance.
Pre-Existing Condition (Job-based Coverage)Any condition (either physical or mental) including a disability for which medical advice, diagnosis, care, or treatment was recommended or received…
Pre-existing condition exclusionThe period of time that an individual receives no benefits under a health benefit plan for an illness or medical condition for which an individual…
Pre-existing Condition Insurance Plan (PCIP)(PCIP)A program that will provide a health coverage option for you if you have been uninsured for at least six months, you have a pre-existing condition, and…
PreauthorizationA decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically…
Preferred ProviderA provider who has a contract with your health insurer or plan to provide services to you at a discount.
Preferred Provider Organization (PPO)(PPO)A preferred provider organization (PP0) is a network of doctors and other healthcare providers that offers discounted care to members of a sponsoring…
Premium Tax CreditThe Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace.
Prescription DrugYou must have a doctor's prescription to receive a prescription drug.
Prescription Drug CoverageHealth insurance or plan that helps pay for prescription drugs and medications.
Prescription DrugsDrugs and medications that, by law, require a prescription.
PreventionActivities to prevent illness such as routine check-ups, immunizations, patient counseling, and screenings.
PreventiveUnder the law, all health plans must cover certain preventive health services. Routine health care that includes screenings, checkups, and patient…
Preventive MedicineHealth care designed to prevent disease or discover and treat disease in the early stage.
Preventive ServicesRoutine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Primary CareHealth services that cover a range of prevention, wellness, and treatment for common illnesses.
Primary Care PhysicianA physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for…
Primary Care Physician (PCP)(PCP)Your Primary Care Physician ("PCP") is the doctor you choose to provide basic health care.
Primary Care ProviderA physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as…
Prior AuthorizationApproval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by…
ProviderAny person or place that provides health care or prescription drugs. Providers can be doctors, hospitals, pharmacies, chiropractors, etc.
Provider CategoryThe category listed is the medical specialty for the health care practitioner, such as internal medicine or neurology.
Public HealthA field that seeks to improve lives and the health of communities through the prevention and treatment of disease and the promotion of healthy behaviors…
Qualified Health PlanUnder the Affordable Care Act, starting in 2014, an insurance plan that is certified by the Health Insurance Marketplace, provides essential health…
Qualifying Life EventA change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage.
Rate ReviewA process that allows state insurance departments to review rate increases before insurance companies can apply them to you.