Glossary of Terms

Medicaid

A state-administered health insurance program for low-income individuals and families, pregnant women, the elderly, and people with disabilities. The federal government provides a portion of the funding for Medicaid and sets guidelines for the program. States also have choices in how they design their program, so Medicaid varies by state…

Medical Loss Ratio (MLR)

A basic financial measurement used in the Affordable Care Act (ACA) to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers’ medical claims and activities that improve the quality of care, the company has a medical…

Medically Necessary

Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.

Medicare

A federal health insurance program for people aged 65 or older and certain younger people with disabilities. Medicare also covers people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Individuals apply for Medicare through the Social Security Administration and not through Washington Healthplanfinder.

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 of your Medicare Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account…

Medicare Part D

A program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage. There are two ways to get Medicare prescription drug coverage: 1) through a Medicare Prescription Drug Plan or 2) through a Medicare Advantage Plan that includes drug coverage.

Metal Levels

Health plans through Washington Healthplanfinder come in four categories, called metal levels. They’re available in Bronze, Silver, Gold, and Platinum. The difference between the plans is what percentage of the cost of care they cover (for example, Bronze plans cover 60% of the costs, where Gold covers 80%).

Minimum Essential Coverage

The type of coverage an individual must have to meet the individual responsibility requirement under the Affordable Care Act (ACA). This includes individual market policies, job-based coverage, Medicare, Washington Apple Health, TRICARE, and certain other coverage.

Minimum Value

A health plan meets this standard if it is designed to pay at least 60% of the total cost of medical services for a standard population.

Modified Adjusted Gross Income (MAGI)

The figure used to determine eligibility for lower costs in Washington Healthplanfinder and for Washington Apple Health. Generally, this MAGI figure is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have. Washington Healthplanfinder calculates your modified adjusted gross income when you enter your application.

Multi-State Plan

A multi-state plan is health insurance that covers you when you travel to different states. Coverage areas may vary according to your plan.