Insurance Plans
If your premium isn’t paid, this can happen to your insurance your insurance coverage.
What is it can be canceled/terminated
Is a federal program primarily for people 65+ or with disabilities.
What is Medicare
You must stay in-network, pick a main doctor, and get referrals to see specialists.
What is HMO (Health Maintenance Organization)
Checking whether a doctor is in network before your visit can help you avoid this.
What is surprise costs / higher bills
When a provider sends the request for payment to the insurer, they are submitting this.
What is a claim?
If your doctor is not in your network, you will usually pay this.
What is more money / higher costs?
Is a state-run program for low-income individuals
What is Medicaid
Offers greater flexibility, allowing members to see out-of-network providers
What is PPO (Preferred Provider Organization)
Reading your benefits before care helps you understand this.
What is what is covered / your costs?
If a service is denied, you have the right to request this.
What is an appeal?
Coverage you receive through where you work.
What is employer-sponsored insurance?
A person who has both programs at the same time is often called this.
What is dual eligible
Only covers in-network care, but does not require a PCP referral
What is EPO (Exclusive Provider Organization)
Choosing urgent care instead of the ER for non-life-threatening issues can greatly reduce this
What is total cost?
The difference between what a provider charges and what insurance allows may be written off as this
What is an adjustment/discount?
Insurance someone buys on their own through the Marketplace or directly from a company.
What is individual / private insurance?
Programs can vary from state to state, while this program is largely federal and similar nationwide.
What is Medicare?
Requires a PCP and in-network, but allows, with higher cost-sharing, out-of-network services
What is POS (Point-of-Service Plan)
Understanding your plan each year before you enroll is part of being this type of healthcare user.
What is an informed consumer?
When a patient is billed for the difference between the provider charge and insurance payment outside the network,
What is balance billing
Someone who wants the lowest monthly payment and rarely sees a doctor might prefer this kind of plan design.
What is a high deductible plan?
Long-term nursing home care is more commonly covered by this program
What is Medicaid
If you want nationwide flexibility and fewer gatekeeping rules, you might select this type of plan.
What is PPO
Keeping your insurance card with you ensures providers can access this information
What is your policy
If a provider fails to obtain required prior authorization before performing a service, the insurer may refuse payment and place the financial burden on this party
Who is the patient