Word of the day

Monday, June 22

Quality Improvement Organization (QIO)

An organization tasked with reviewing the quality of care received by Medicare and Medicaid beneficiaries. Previously called a Peer Review Organization.

Friday, June 19

Hardship Exemption

Because of the individual mandate under the Affordable Care Act, most people must pay a fee if they don't have health coverage that qualifies as "minimum essential coverage." One exception is based on showing that a "hardship" prevented them from becoming insured. If an individual is homeless, recently experienced domestic violence, experienced the death of a close family member, filed for bankruptcy in the last 6 months, or any of several other qualifiers, a “hardship exemption” from the penalty may apply. Hardship exemptions are usually provided for the month before the hardship, the months of the hardship, and the month after the hardship, including up to a full calendar year.

Wednesday, June 17

Medicare Part D

A program within Medicare to offer private prescription drug coverage plans to beneficiaries. Plan premiums are subsidized and the coverage is optional.

Tuesday, June 16

Food and Drug Administration (FDA)

Agency under the U.S. Department of Health and Human Services that regulates the approval of all new drugs, biologics and medical devices as well as overseeing food and other products.

Monday, June 15

Limited Service Hospital

Hospitals that offer a limited range of services - most often rural hospitals.

Wednesday, June 10

Redetermination

The process wherein individuals that are currently enrolled in an exchange plan (either state or federal) must re-establish their eligibility on an annual basis.

Wednesday, June 3

National Association of Insurance Commissioners (NAIC)

Organization of state insurance regulators.

Tuesday, June 2

Medicare Advantage (MA)

A health insurance program of managed health care approved by Medicare and provided by private companies. Medicare Advantage plans combine Medicare Part A (hospital coverage) and B (doctor coverage) plus additional benefits all in one plan. Also known as Medicare Part C.

Monday, June 1

Minimum Medical Loss Ratio for Insurers

Ratio of insurance expenditures used on care as opposed to administrative or other costs. Under ACA insurance companies are required to issue rebates to consumers if too large a share of the expenditures are allocated to costs not directly associated with care (max of 15% for large group plans, max of 20% for individual or small group plans).

Friday, May 29

Waiting Period

A required amount of time that an individual must remain with the same employer before they are eligible for health insurance.

Dual Eligibles

Medicare Part A and/or B recipients who either qualify for Medicare Savings Program or qualify for Medicaid benefits.