Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
Risk Adjustment
A process used by health insurance companies to adjust payments based on the health status of their enrollees. It ensures that plans enrolling higher-risk individuals (such as those with chronic conditions) are compensated to maintain financial stability. Medicare Advantage and ACA Marketplace plans use risk adjustment.
A process used by health insurance companies to adjust payments based on the health status of their enrollees. It ensures that plans enrolling higher-risk individuals (such as those with chronic conditions) are compensated to maintain financial stability. Medicare Advantage and ACA Marketplace plans use risk adjustment.
Special Enrollment Period (SEP)
A time outside the Open Enrollment Period when individuals can sign up for or change their health insurance plan due to qualifying life events such as marriage, birth of a child, or loss of other coverage. SEPs apply to both ACA Marketplace and Medicare plans.
A time outside the Open Enrollment Period when individuals can sign up for or change their health insurance plan due to qualifying life events such as marriage, birth of a child, or loss of other coverage. SEPs apply to both ACA Marketplace and Medicare plans.
Silver Plan (ACA)
A mid-level health plan available through the ACA Marketplace that covers approximately 70% of healthcare costs, with the enrollee paying the remaining 30%. Cost-sharing reductions are only available for those who select a Silver plan and meet income requirements.
A mid-level health plan available through the ACA Marketplace that covers approximately 70% of healthcare costs, with the enrollee paying the remaining 30%. Cost-sharing reductions are only available for those who select a Silver plan and meet income requirements.
Tax Penalty (ACA)
A financial penalty imposed on individuals who did not have health insurance coverage under the ACA's individual mandate. Although the federal tax penalty was reduced to $0 in 2019, some states still impose penalties for not having qualifying health coverage.
A financial penalty imposed on individuals who did not have health insurance coverage under the ACA's individual mandate. Although the federal tax penalty was reduced to $0 in 2019, some states still impose penalties for not having qualifying health coverage.
TRICARE
A healthcare program for uniformed service members, retirees, and their families. Medicare coordinates with TRICARE to provide comprehensive coverage for military retirees who are eligible for both programs.
A healthcare program for uniformed service members, retirees, and their families. Medicare coordinates with TRICARE to provide comprehensive coverage for military retirees who are eligible for both programs.
Waiting Period
The period of time between the date a person applies for health insurance and the date coverage begins. Waiting periods are sometimes imposed in employer-sponsored health plans, but under the ACA, they cannot exceed 90 days. Medicaid and CHIP usually do not have waiting periods for coverage.
The period of time between the date a person applies for health insurance and the date coverage begins. Waiting periods are sometimes imposed in employer-sponsored health plans, but under the ACA, they cannot exceed 90 days. Medicaid and CHIP usually do not have waiting periods for coverage.