Federal poverty level (FPL)

A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.

Employer shared responsibility payment (ESRP)

The Affordable Care Act requires certain employers with at least 50 full-time employees (or equivalents) to offer health insurance coverage to its full-time employees (and their dependents) that meets certain minimum standards set by the Affordable Care Act or to make a tax payment called the ESRP.

Primary care physician

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.

Claim

A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.

Formulary

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Household

The Marketplace generally considers your household to be you, your spouse if you’re married, and your tax dependents. Your eligibility for savings is generally based on the income of all household members, even those who don’t need insurance.

Medicare hospital insurance tax

A tax under the Federal Insurance Contributions Act (FICA) that is a United States payroll tax imposed by the federal government on both employees and employers to fund Medicare.

Risk adjustment

A statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs.

Medicare prescription drug donut hole

Medicare drug plans previously had a coverage gap (also called the “donut hole”). The donut hole was a temporary limit on what the drug plan would cover for drugs.

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