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25 terms you should know to understand the health care debate

  • Medicare Part D

    Medicare Part D is an option for prescription drug coverage available to Medicare recipients. It charges monthly fees and premiums, may have deductibles, and may charge copayments.

  • Family and Medical Leave Act

    The federal Family and Medical Leave Act guarantees up to 12 weeks of job-protected leave when employees need to take time off due to serious illness or disability, to have or adopt a child, or to care for a family member. But it does not guarantee that employees who use the act will get paid. Only California, New Jersey, Rhode Island, New York, Washington, and the District of Columbia have paid family leave programs.

  • Health insurance exchange

    A health insurance exchange is a marketplace to shop for health insurance. Private insurance companies list their health plans, and consumers can comparison shop. They are for people who do not obtain health insurance through an employer or a government-run program like Medicare or Medicaid. The exchanges were developed by the government under the Affordable Care Act.

  • Premium tax credit

    Under the Affordable Care Act, government subsidies such as the premium tax credit are available to help people cover health insurance costs. Eligibility is based on income, capped at 400 percent of the federal poverty level. The credit is available only to those buying health insurance through their state’s government-run health insurance exchange. In an update to the Affordable Care Act, proposed to the U.S. House for a vote on June 29, 2020, the premium tax credit may be raised for commercial health insurance.

  • Cadillac tax

    So-called Cadillac health insurance is a high-cost plan with little or no out-of-pocket expenses. A Cadillac tax, already delayed by Congress but due to take effect in 2022, will levy a 40% tax on the portion of employer-sponsored health insurance premiums above a certain level. The goal is to make high-end health coverage less attractive, based on the view that employees over-use plans with little cost-sharing. The Congressional Budget Office estimated that about 15% of covered workers participate in plans likely to be affected. Employers are likely to respond with higher deductibles, co-pays and out-of-pocket maximums.

    [Pictured: Director of the Congressional Budget Office Douglas Elmendorf.]

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  • Donut hole

    The term donut hole applies to a gap in Medicare prescription drug coverage. After a patient has spent a certain amount on covered drugs, the patient must pay all costs out-of-pocket up to a yearly limit. Once the yearly limit is met, the coverage gap ends and the plan helps pay for covered drugs again.

  • Medicaid buy-in

    A Medicaid buy-in would give people the option to purchase a plan similar to Medicaid. It would be aimed at those who could not afford private coverage. A buy-in program exists in most states for people with disabilities, allowing them to keep their health care coverage if they start or resume working.

  • Children’s Health Insurance Program

    The Children's Health Insurance Program (CHIP) is designed to provide coverage to children in families that earn too much money to qualify for Medicaid. Eligibility requirements vary by state. Coverage includes routine checkups, immunizations, doctor visits, prescriptions, hospital care, and emergency services. Some states charge co-payments or premiums but they are limited to 5% of family income.


    COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that allows workers to keep their health coverage temporarily after their employment ends. Under COBRA coverage, consumers pay 100% of the premiums, including the share their employers paid.

  • Medicare for All

    Medicare for All is a political proposal that could mean a government-run, single-payer health care system, or a system allowing Americans to buy into Medicare at age 50, also called Medicare for More. It differs from the Affordable Care Act, which left private insurers paramount.

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