Glossary of Healthcare Terms

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Medicare

Medicare is an entitlement program available to individuals over the age of 65 and individuals with End Stage Renal Disease (ESRD).

Originally known as Medicare+Choice, a federally developed managed are model for Medicare, refined under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. "Medicare Advantage is a system for delivering Medicare benefits to beneficiaries who enroll in plans offered by private health insurance organizations."

Medicare Part A

“The Democratic plan for a compulsory hospital insurance program under Social Security.”

Medicare Part B

“The revised Republican program of government-subsidized voluntary insurance to cover physicians’ bills.”

Metropolitan Statistical Area

Typically, a geographic area that includes one city with at least 50,000 inhabitants.

Mid-Level Provider

Health practitioners that must hold a license to practice medicine and may (in some capacity) practice independently.

Mid-Level Providers

A subset of licensed nonphysician practitioners that generally practices under the supervision of physicians but is allowed some autonomy in practice, whether in regard to prescriptive authority or the ability to provide some level of independent care.

Minimum Essential Coverage

Level of coverage that includes insurance offered in the individual market (such as qualified health plan enrolled in through an Affordable Insurance Exchange), an eligible employer-sponsored plan, or government-sponsored coverage such as Medicare, Medicaid, the Children's Health Insurance Program, TRICARE, or veteran's health.

Minority Interest

An ownership interest that lacks the aspects of control necessary to direct the economic and financial strategies employed by the firm, i.e., anything less than a majority interest in a firm.

Modifier

A code that is added to a base code (e.g., DRG or CPT) to take into account a circumstance that may impact the cost of care.

Monopsony

"A single purchaser in a healthcare market without rivals."

National Committee on Quality Assurance (NCQA)

A not-for-profit organization that works to improve the quality of healthcare through the accreditation of managed care plans. NCQA performs this duty, much like other accrediting bodies, through the setting of standards and collection of outcome and performance data.

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