A system of health care that attempts to regulate the cost and quality level of health related services. The majority of managed care programs offer HMO and PPO plans, and some place special emphasis on preventive care by making it more available. Recent studies have shown that about 90% of insured individuals use some type of managed care.
Maximum Dollar Limit
The limit that an insurer is willing to pay for claims in a certain time frame. These dollar amounts are very variable, at times they depend on types of services you receive, or illnesses you may have. Maximum dollar limits can be specified for a lifetime or annually.
A health insurance program run by the state, which provides coverage for low income families, children, elderly, pregnant women, disabled, and other individuals depending on the state. Medicaid is partially funded by the federal government, and they also control the framework of the program. Every state has its own ability to set up their individual Medicaid program, however, and is sometimes referred to as Medical Assistance or have another name (like Medi-Cal in California). For more information, read this article.
Medical Loss Ratio (MLR)
Part of the Affordable Care Act, the Medical Loss Ratio is a financial measurement used to enforce affordability in health insurance companies. The MLR attempts to regulate the spending of insurance companies on costs other than health care for its customers (such as marketing, bonuses, profits, salaries, and other internal costs). If 80 cents of every dollar made from premiums is spent on claims and other services that improve the quality of health care, that means the other 20 cents are being spent on their company. The goal is to ensure the focus of the insurance company is to better serve the people paying for their services.
The process of determining an individual’s eligibility and health status when applying for health insurance, used by insurance companies. Underwriting will decide whether you will receive coverage at all, and if so, how much you will pay, and if there will be any exclusions or limits. For more about underwriting, visit our Underwriting section of the site.
A government-funded and operated health insurance program for individuals who are 65 and older, and some who are younger and have disabilities. Those who have been diagnosed with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (kidney failure) are also eligible for Medicare.
Minimum Essential Coverage
Under the Affordable Care Act, an individual must have a health plan with a certain amount of “essential” benefits covered in order to meet the individual mandate. This applies to plans through individual health insurance, employer group insurance, Medicare, Medicaid, CHIP, and some other types of coverage.
1. HealthInsurance.org, “Health insurance glossary”. http://www.healthinsurance.org/glossary/
2. HealthCare.gov, “Glossary – M”. http://www.healthcare.gov/glossary/m/index.html