Insurance Terms
Insurance payment for coverage of healthcare benefits
What is a premium?
Medicare Part covering hospitalization costs
What is Medicare Part A?
The insurance program jointly funded by federal and state governments primarily to provide care for the poor.
What is Medicaid?
Fundamental goal of the Affordable Care Act of 2010
What is reduce the number of uninsured?
Healthcare insurance that helps pay for medical bills by providing a set amount of money for specific services.
What is indemnity insurance?
Payment model where a healthcare provider is paid a set fee for each individual medical service performed.
What is Fee for Service?
The fixed dollar amount that an insured beneficiary must pay before the insurer pays for medical services
What is a deductible?
Medicare Part covering costs of physician and non-hospital based care
What is Medicare Part B?
Medicaid was a key component of this ACA program for increasing healthcare access.
What is Medicaid expansion?
ACA provision that requires most US citizens and legal residents to have health insurance.
What is the individual mandate?
A cost-saving managed care organization that generally restricts patient access only to in-network providers except in emergency.
What are Health Maintenance Organizations?
Payment model where a healthcare provider is paid a fixed amount of money per patient over a period of time, regardless of the number or type of services provided.
What is Capitation?
The insured beneficiaries responsibility for a percentage of the cost of care after the deductible is met
What is coinsurance?
An optional Medicare benefit that helps pay for prescription drugs.
What is Medicare Part D?
Provides monthly payments to help with the cost of food, clothing, and shelter for older, blind, and/or disabled Americans with little or no income
What is Supplemental Security Income?
ACA requirement that all employers with 50 or more full-time workers provide health insurance or pay a penalty.
What is the employer mandate?
A less restrictive managed care organization that permits patient access to out-of-network providers at a higher cost.
What are Preferred Provider Organizations (PPOs)?
The process of reviewing the appropriateness and quality of care provided to patients.
What is utilization review?
The fixed dollar amount an insured beneficiary is required to pay when services are received.
What is a copayment?
Known as Medicare Advantage Plans
What is Medicare Part C?
Provides supplemental foods, health care referrals, and nutrition education for this category of beneficiary
What is the WIC Program?
Nickname for the individual and small business insurance marketplaces required by the ACA
What are Exchanges?
High deductibles and Health Savings Accounts are features of this plan.
What are Consumer Directed Health Plans?
Requirement to receive preapproval before receiving high cost healthcare.
What is prior authorization?
A payment total beyond which the insurance company will no longer provide coverage
What are annual and lifetime benefit caps
Medicare is offered to Americans over 65, disabled Americans under 65, and Americans suffering from what disease?
What is End Stage Renal Disease?
Free, voluntary program in Texas that helps first-time mothers improve pregnancy outcomes and improve childhood growth
Free, voluntary program in Texas that helps first-time mothers improve pregnancy outcomes and improve childhood growth
Arguably the most favorably regarded provision of the ACA
What are the pre-existing conditions provisions?
Groups of healthcare providers that work together to provide high-quality care to Medicare patients
What are Accountable Care Organizations?
Health insurer whose CEO was the recent victim of a targeted killing.
What is UnitedHealthcare?