Glossary: M

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Mail-order drugs See “Maintenance medications.”

Mail-order pharmacy People can get prescription drugs through the mail with this. It is a service that health plans often offer. Members can save time and money using it by getting a three-month supply all at once. Aetna Rx Home Delivery® is the name of Aetna’s mail-order pharmacy.

Maintenance medications These are prescription drugs that people take on a regular basis. These drugs help treat chronic conditions. These drugs include ones for asthma, diabetes, high blood pressure and other health conditions. Buying them through a mail-order pharmacy can save money.

Malignant This is a word to describe a tumor. It means the tumor is cancerous. It is cancer. It can grow and spread in the body. (See also metastatic or metastasize.)

Managed care This is a type of health plan. It signs an agreement with doctors and hospitals to form a network. Members may get a higher level of benefits if they use doctors or hospitals in this network. Costs are often higher when people go out of the network for care. The plan may also require preapproval of some services.

Managed care company This is a health insurance company. (See also managed care.)

Mandated benefits These are the benefits that health care plans must provide. State or federal law require them.

MA plan This is a type of Medicare Advantage plan. It does not cover prescription drugs.

MA-PD plan This is a type of Medicare Advantage plan. It covers prescription drugs

Maximum benefit amount This is an amount of money that is paid to people through a disability plan or life insurance policy. It is the most that they can receive in one period. That could mean every week, every month, or once a year. The plan spells out how often this amount is paid.

Maximum benefit period Some employers offer disability plans. These plans help people who cannot work because of illness or injury. The plan pays a part of their income for a time.
This is the amount of time employees can receive a benefit amount through their disability plan. It is the longest period of time that they can collect this money.

Maximum drug benefit This is a type of limit that some health plans have. It is the most the plan will pay for prescription drugs for a period of time. If a member’s drug costs reach that limit within the time period, the plan will not cover the drug costs for the rest of that time.

Medicaid Medicaid is a state government program. It provides health care coverage. It is meant for people with low incomes. This includes families and children.

Medical condition This is a disease, illness or health problem for which you seek treatment.

Medical emergency See “Emergency.”

Medical underwriting See “Evidence of Insurability.”

Medically necessary See “Necessary.”

Medicare This is a program of the federal government. It provides health care coverage. It is for people:
age 65 or older
with certain disabilities
who have permanent kidney failure, with
dialysis
transplant.

Medicare Advantage plan See “Medicare Part C.”

Medicare limiting charge This applies to a health care provider. The provider does not participate in Medicare. There is a limit on how much the provider can charge for a service covered by Medicare. The limit is 15% more than the amount Medicare allows for the service.

Medicare Modernization Act This is a law. It:
strengthened the current Medicare program
added coverage for preventive care
created the Medicare Part D prescription drug plan
gave extra help to people with low incomes.

Medicare Part A This is part of the original Medicare plan. It is managed by the federal government. It covers some, but not all, expenses for:
inpatient care at a hospital

medical care at a Skilled nursing facility

hospice care

Home Health Care.
The plan has limits. People also must pay deductibles, copaysand other costs.

Medicare Part B This is part of the original Medicare plan managed by the federal government. People sign up for this plan. They usually pay a monthly premium for the plan. It covers:

necessary services from doctors
Outpatient care from a hospital.
It also pays some costs for some:

Physical therapy

occupational therapy

Home Health Care.

Medicare Part C This is a Medicare program. It is open to most people who have Medicare Part A and Medicare Part B plans.
It provides medical and other benefits. These are provided through health plan companies approved by the federal government. The coverage is offered through Medicare Advantage plans. These plans can be:

Health maintenance organizations

Preferred provider organizations

Medicare Private Fee-for-Service plans.

When people use doctors and hospitals in the plans’ networks, they get more coverage. That means they might pay less.
Some of these plans cover prescription drugs. That is an MA-PD plan. Some do not cover prescription drugs. That is an MA plan.

Medicare Part D This is an optional Medicare plan. It provides coverage for some prescription drugs.

It can be offered as part of a Medicare Advantage plan. This is called an “ MA-PD.”

It also can be offered separately from the Medicare plan. This is called a “ Medicare prescription drug plan” or “ PDP.”

Medicare prescription drug plan This is an optional Medicare plan. It is separate from a Medicare health plan. It provides coverage for some prescription drugs. It is offered through a private company. Sometimes, it is called a “PDP.”

Medicare supplement plan This is an insurance policy. It is offered through private companies. It helps pay for some benefits not covered by Medicare Part A and Medicare Part B. New plans of this type do not cover prescription drugs. It is also known as “ Medigap” coverage.

Medication This is a drug a person takes. It can be a prescription drug or an over-the-counter drug.

Medigap See “Medicare supplement plan.”

Member A member is someone who belongs to a health plan. Sometimes, a member is known as an “enrollee.”

Member Services This is a department in a health plan company. It helps people understand how their health plan works. It can:

answer questions on the phone

mail out plan documents

replace member ID cards.

People usually find the phone number for Member Services on their ID card.

Membrane This is a thin, flexible layer of tissue. It covers or connects a part or area of the body.

Menopause Women in this stage of life no longer get their period.

Menses This means a woman’s period.

Mental disorder This is a problem with brain function. It affects the way people see themselves and the world they live in. It may also affect how they act.
Examples include depression, post-traumatic stress and schizophrenia. These types of conditions are not always easy to recognize. They don’t show up on blood tests or X-rays.

Metastatic (metastasize) This is a word that describes cancer. It means that the cancer has spread.

Methodology This is a method, or process that is followed.

Mg This stands for milligram. It is a very small amount used to measure drugs.

Microalbuminuria This is a condition in which high levels of protein are found in the urine. This could signal a kidney problem.

Minimum benefit Disability plans provide a source of income for people who cannot work because of illness or injury. Income from other sources may reduce the amount of payment made under the plan. The minimum benefit is the least amount of money a person can get from the plan.
See “Other income benefits.”

Modify This means to change. For example, a doctor suggests that you modify your diet. That means he or she wants you to change the way you eat.

Monitor This means to keep track of something. For example, a doctor wants to monitor your blood pressure. That means he or she wants to watch it, check it over a period of time to make sure there is nothing wrong.

Monthly benefit This is for employees who are disabled and covered under a long-term disability plan. It is the amount they can get each month. They get this only while they are not able to work for a period of time.

Monthly plan premium This is the payment you make every month to a health plan. You are paying for the health insurance coverage the health plan provides.

Glossary: M

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Plans and Benefits

Mail-order drugs	See “Maintenance medications.”
Mail-order pharmacy	People can get prescription drugs through the mail with this. It is a service that health plans often offer. Members can save time and money using it by getting a three-month supply all at once. Aetna Rx Home Delivery® is the name of Aetna’s mail-order pharmacy.
Maintenance medications	These are prescription drugs that people take on a regular basis. These drugs help treat chronic conditions. These drugs include ones for asthma, diabetes, high blood pressure and other health conditions. Buying them through a mail-order pharmacy can save money.
Malignant	This is a word to describe a tumor. It means the tumor is cancerous. It is cancer. It can grow and spread in the body. (See also metastatic or metastasize.)
Managed care	This is a type of health plan. It signs an agreement with doctors and hospitals to form a network. Members may get a higher level of benefits if they use doctors or hospitals in this network. Costs are often higher when people go out of the network for care. The plan may also require preapproval of some services.
Managed care company	This is a health insurance company. (See also managed care.)
Mandated benefits	These are the benefits that health care plans must provide. State or federal law require them.
MA plan	This is a type of Medicare Advantage plan. It does not cover prescription drugs.
MA-PD plan	This is a type of Medicare Advantage plan. It covers prescription drugs
Maximum benefit amount	This is an amount of money that is paid to people through a disability plan or life insurance policy. It is the most that they can receive in one period. That could mean every week, every month, or once a year. The plan spells out how often this amount is paid.
Maximum benefit period	Some employers offer disability plans. These plans help people who cannot work because of illness or injury. The plan pays a part of their income for a time. This is the amount of time employees can receive a benefit amount through their disability plan. It is the longest period of time that they can collect this money.
Maximum drug benefit	This is a type of limit that some health plans have. It is the most the plan will pay for prescription drugs for a period of time. If a member’s drug costs reach that limit within the time period, the plan will not cover the drug costs for the rest of that time.
Medicaid	Medicaid is a state government program. It provides health care coverage. It is meant for people with low incomes. This includes families and children.
Medical condition	This is a disease, illness or health problem for which you seek treatment.
Medical emergency	See “Emergency.”
Medical underwriting	See “Evidence of Insurability.”
Medically necessary	See “Necessary.”
Medicare	This is a program of the federal government. It provides health care coverage. It is for people: age 65 or older with certain disabilities who have permanent kidney failure, with dialysis transplant.
Medicare Advantage plan	See “Medicare Part C.”
Medicare limiting charge	This applies to a health care provider. The provider does not participate in Medicare. There is a limit on how much the provider can charge for a service covered by Medicare. The limit is 15% more than the amount Medicare allows for the service.
Medicare Modernization Act	This is a law. It: strengthened the current Medicare program added coverage for preventive care created the Medicare Part D prescription drug plan gave extra help to people with low incomes.
Medicare Part A	This is part of the original Medicare plan. It is managed by the federal government. It covers some, but not all, expenses for: inpatient care at a hospital medical care at a Skilled nursing facility hospice care Home Health Care. The plan has limits. People also must pay deductibles, copaysand other costs.
Medicare Part B	This is part of the original Medicare plan managed by the federal government. People sign up for this plan. They usually pay a monthly premium for the plan. It covers: necessary services from doctors Outpatient care from a hospital. It also pays some costs for some: Physical therapy occupational therapy Home Health Care.
Medicare Part C	This is a Medicare program. It is open to most people who have Medicare Part A and Medicare Part B plans. It provides medical and other benefits. These are provided through health plan companies approved by the federal government. The coverage is offered through Medicare Advantage plans. These plans can be: Health maintenance organizations Preferred provider organizations Medicare Private Fee-for-Service plans. When people use doctors and hospitals in the plans’ networks, they get more coverage. That means they might pay less. Some of these plans cover prescription drugs. That is an MA-PD plan. Some do not cover prescription drugs. That is an MA plan.
Medicare Part D	This is an optional Medicare plan. It provides coverage for some prescription drugs. It can be offered as part of a Medicare Advantage plan. This is called an “ MA-PD.” It also can be offered separately from the Medicare plan. This is called a “ Medicare prescription drug plan” or “ PDP.”
Medicare prescription drug plan	This is an optional Medicare plan. It is separate from a Medicare health plan. It provides coverage for some prescription drugs. It is offered through a private company. Sometimes, it is called a “PDP.”
Medicare supplement plan	This is an insurance policy. It is offered through private companies. It helps pay for some benefits not covered by Medicare Part A and Medicare Part B. New plans of this type do not cover prescription drugs. It is also known as “ Medigap” coverage.
Medication	This is a drug a person takes. It can be a prescription drug or an over-the-counter drug.
Medigap	See “Medicare supplement plan.”
Member	A member is someone who belongs to a health plan. Sometimes, a member is known as an “enrollee.”
Member Services	This is a department in a health plan company. It helps people understand how their health plan works. It can: answer questions on the phone mail out plan documents replace member ID cards. People usually find the phone number for Member Services on their ID card.
Membrane	This is a thin, flexible layer of tissue. It covers or connects a part or area of the body.
Menopause	Women in this stage of life no longer get their period.
Menses	This means a woman’s period.
Mental disorder	This is a problem with brain function. It affects the way people see themselves and the world they live in. It may also affect how they act. Examples include depression, post-traumatic stress and schizophrenia. These types of conditions are not always easy to recognize. They don’t show up on blood tests or X-rays.
Metastatic (metastasize)	This is a word that describes cancer. It means that the cancer has spread.
Methodology	This is a method, or process that is followed.
Mg	This stands for milligram. It is a very small amount used to measure drugs.
Microalbuminuria	This is a condition in which high levels of protein are found in the urine. This could signal a kidney problem.
Minimum benefit	Disability plans provide a source of income for people who cannot work because of illness or injury. Income from other sources may reduce the amount of payment made under the plan. The minimum benefit is the least amount of money a person can get from the plan. See “Other income benefits.”
Modify	This means to change. For example, a doctor suggests that you modify your diet. That means he or she wants you to change the way you eat.
Monitor	This means to keep track of something. For example, a doctor wants to monitor your blood pressure. That means he or she wants to watch it, check it over a period of time to make sure there is nothing wrong.
Monthly benefit	This is for employees who are disabled and covered under a long-term disability plan. It is the amount they can get each month. They get this only while they are not able to work for a period of time.
Monthly plan premium	This is the payment you make every month to a health plan. You are paying for the health insurance coverage the health plan provides.