Wednesday, February 25
Premium
Refers to the amount paid for health insurance, usually on a monthly basis.
Tuesday, February 24
Market Power
The size of one firm relative to its competitors in a given market. Certain insurers or health systems have greater market power which enhances their ability to set prices.
Monday, February 23
Reference Based Pricing
A pricing scheme for prescription drugs that is designed to lower the overall expenditures on pharmaceuticals. The programs lump drugs that target specific issues into groups, and set rates for the group as a whole - usually based on the cost of the cheapest drug. For example, there are a variety of drugs designed to lower blood pressure. Under reference based pricing, the insurance provider would only pay for the cost of the cheapest blood pressure medicine. While these programs do not limit the specific drugs patients may purchase, they only cover a portion of the cost of more expensive drugs in any given category.
Wednesday, February 18
Out-of-network
Heath care providers not within an insurance plan's approved network of care providers.
Tuesday, February 17
Direct Access
A provision of some health insurance plans that allows policy holders to see doctors or specialists without a referral from a primary care physician or 'gatekeeper.'
Tuesday, February 10
Navigator
A third-party agent assigned to conduct public education about the availability of qualified health plans and help eligible consumers with the exchange enrollment process.
Monday, February 9
Medicaid and CHIP Payment Advisory Commission
A committee charged with reviewing and making recommendations regarding state and federal payment policies within the Medicaid and CHIP programs.
Friday, February 6
Purchasing Pool
When small groups or individuals band together to purchase health insurance as a larger unit (and thus presumably at a lower cost). For example several small companies could join together into a purchasing pool to buy coverage for their employees.
Thursday, February 5
Payer
The organization or individual responsible for paying the costs of a health care procedure.