Key insurance terms that start with "M"

A health insurance plan offered in multiple states that meets ACA standards. Multistate plans are available on the health insurance marketplace and offer consistent benefits and pricing across different states. They provide an option for people who travel or move frequently.

A measure of income used to determine eligibility for health insurance subsidies and Medicaid. MAGI is calculated from your adjusted gross income and includes certain types of income that may not be taxable. Your MAGI determines whether you qualify for premium tax credits and cost-sharing reductions.

A measure of how much of your health care costs an employer's health plan is expected to cover. An employer plan must provide minimum value (at least 60% coverage) to avoid employer mandate penalties. Minimum value is different from the metal tiers, which are based on actuarial value.

Health insurance coverage that meets the ACA's standards for being considered creditable coverage. Minimum essential coverage includes most health plans offered in the marketplace, employer plans, government plans, and other types of insurance. Having minimum essential coverage exempts you from the individual mandate penalty.

Health insurance plan categories named after metals: Bronze, Silver, Gold, and Platinum. Each tier represents how much of your health care costs the plan pays. Bronze plans cover 60%, Silver covers 70%, Gold covers 80%, and Platinum covers 90%. Higher metal tiers have higher premiums but lower out-of-pocket costs.

A requirement that health insurance plans cover mental health and substance abuse services equally to physical health services. The Mental Health Parity and Addiction Equity Act requires that copays, coinsurance, deductibles, and visit limits be the same for mental health and physical health services.

The prescription drug coverage part of Medicare. Medicare Part D covers prescription medications for Medicare beneficiaries. You can add Part D coverage when you first enroll in Medicare or during the annual enrollment period. If you don't enroll when eligible, you may face a late enrollment penalty.

A private alternative to original Medicare (Parts A and B) offered by insurance companies. Medicare Advantage plans often include prescription drug coverage and additional benefits. They typically have lower premiums but more restrictions on which providers you can use.

A federal health insurance program for people age 65 and older, regardless of income, as well as some younger people with disabilities. Medicare has several parts (A, B, C, and D) covering hospital care, doctor visits, and prescription drugs. Medicare is separate from the Affordable Care Act marketplace.

A health care service or treatment that a doctor determines is necessary to diagnose or treat your medical condition. Insurance plans only cover services deemed medically necessary. Whether a service is medically necessary can sometimes be a source of disagreement between you and your insurance company.

The process an insurance company uses to evaluate your health and medical history to determine if it will offer you coverage and at what price. Medical underwriting was used to deny coverage or charge higher premiums based on pre-existing conditions before the Affordable Care Act prohibited this practice in the health insurance marketplace.

An expansion of Medicaid eligibility under the Affordable Care Act that allows states to extend coverage to adults earning up to 138% of the federal poverty level. Not all states have expanded Medicaid, so eligibility varies depending on where you live.

A joint federal-state health insurance program that provides free or low-cost coverage to eligible low-income individuals and families. Medicaid covers doctor visits, hospital care, prescription drugs, and other health services. Eligibility and benefits vary by state.

The most you have to pay out of your own pocket for covered services in a year before your insurance plan pays 100%. Once you reach your maximum out-of-pocket limit, your plan pays all covered costs for the rest of the year. Your deductible, copays, and coinsurance all count toward this limit.

A platform where you can compare and enroll in health insurance plans. The federal marketplace (Healthcare.gov) serves most states, while some states operate their own marketplaces. Open enrollment runs from November 1 to January 31 each year.

A health insurance plan that manages care and costs by using a network of providers. Managed care plans include HMO, PPO, EPO, and POS plans. These plans emphasize preventive care and controlling costs through network restrictions and prior authorization requirements.