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Monday, November 24

Gatekeeper

A colloquial term for a primary care physician who is responsible for coordinating patient care and referring the patient to specialists. Many insurance programs, particularly HMOs, require a referral from a "gatekeeper" before covering visits to specialists.

Friday, November 21

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, November 18

Sole Community Hospital (SCH)

A designation for certain hospitals that allows them to command higher reimbursement.

Monday, November 17

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.

Friday, November 14

Silver Plan

The second lowest actuarial level health plans available through the insurance exchanges, equal to a 70 percent actuarial value. An individual’s subsidy is based on the second lowest cost silver plan in their region. Bronze, Gold, and Platinum plans offer varying actuarial values.

Coverage of Preventive Benefits

Provision in the ACA requiring full coverage of preventative services with no cost-sharing, including children’s’ immunizations and women’s screenings and care.