Medicare and Medicaid
This federal health insurance program generally becomes available to Americans at age 65.
Medicare
The amount a patient generally must pay toward covered healthcare costs before their insurance begins paying for certain services.
Deductible
This federal law requires hospital emergency departments to provide an appropriate medical screening examination for patients seeking emergency care.
EMTALA
Under this payment model, performing more billable services generally generates more reimbursement.
Fee-for-service
A patient's ability to understand and use health information is known as this.
Health Literacy
Unlike Medicare, this program is jointly funded by the federal government and individual states.
Medicaid
This is the fixed amount a patient typically pays for a covered healthcare service, such as $30 for an office visit.
Copayment
This law establishes federal protections for the privacy and security of protected health information.
HIPAA
This federal program determines physician reimbursement using a system that assigns relative values to different medical services.
Medicare Physician Fee Schedule
This concept refers to providing people with resources based on their individual needs rather than giving everyone identical resources.
This Medicare component covers prescription medications.
Part D
When having insurance causes someone to use more healthcare because they are shielded from the full cost, this phenomenon is called this.
Moral Hazard
This federal law protects certain patients from unexpectedly receiving bills from out-of-network providers in covered situations.
No Surprises Act
These units are commonly used by Medicare to help determine physician reimbursement.
RVUs
When people with similar healthcare needs receive different levels of care because of factors such as income, geography, or race, this concept may be present.
Health Disparity
This program provides health coverage to eligible children whose families earn too much to qualify for Medicaid but may not afford private insurance.
CHIP
When people at higher health risk are disproportionately likely to purchase insurance, this phenomenon can occur.
Adverse Selection
Under EMTALA, a hospital that has determined a patient has an emergency medical condition generally must either provide stabilizing treatment or do this.
Arrange appropriate transportation
Under this model, a physician or organization receives a predetermined payment per patient over a specified period.
Capitation
This framework emphasizes that health outcomes can be shaped by policies, institutions, economic systems, and the conditions in which people live.
Structural Determinants of Health
Unlike traditional Medicare, this option allows beneficiaries to receive Medicare-covered benefits through a private health plan.
Medicare Advantage
This approach to healthcare payment attempts to shift incentives away from volume and toward quality, outcomes, and cost efficiency.
Value-based care
This federal law generally prohibits hospitals from discriminating against patients based on certain characteristics and is particularly relevant to federally funded healthcare programs.
Section 1557 of the ACA
A surgeon, hospital, and other providers receive one combined payment for all services associated with a particular episode of care.
Bundled Payment
A low-income patient earns too much to qualify for Medicaid but too little to afford private coverage. This situation has historically been associated with this ACA-related phenomenon.
Medicaid Coverage Gap