insurances basics
the main purpose of health insurance
To help pay for healthcare expenses and protect people from the full cost of medical care.
what does HMO stand for ?
Health Maintenance Organization.
What is managed care?
A system for organizing and coordinating healthcare while controlling costs and encouraging appropriate use of medical services.
What is a copayment?
A fixed amount a patient pays for a covered healthcare service, such as $25 for a doctor's visit.
A patient has a $1,000 deductible and has paid $0 toward it. They receive a covered service costing $600. How much would generally be applied toward their deductible?
$600.
what is a premium
A premium is the amount a person pays for health insurance coverage.
What does PPO stand for?
Preferred Provider Organization.
What is a primary care provider?
A healthcare professional who provides routine and ongoing care and helps coordinate a patient's healthcare.
What does "in-network" mean?
A healthcare provider that has a contract with an insurance plan.
Why might a patient choose an in-network doctor instead of an out-of-network doctor?
The patient will generally pay less when using an in-network provider.
what is a deductible
the amount a person must pay for covered healthcare services before the insurance plan begins paying its share.
What is Medicare?
A federal health insurance program primarily for people age 65 and older, along
What is a healthcare provider network?
A group of doctors, hospitals, and other healthcare providers that have agreements with an insurance plan.
What does "out-of-network mean?
A healthcare provider that does not have a contract with the patient's insurance plan.
A patient has a $30 copay for a doctor's visit. What does that mean?
The patient generally pays $30 for the covered visit.
what is co insurance
Co insurance is the percentage of the cost of a covered healthcare service that the patient pays after meeting the deductible.
What is Medicaid?
A joint federal and state program that provides health coverage to eligible people with limited income
What is telehealth?
The use of electronic communication and technology to provide healthcare services remotely.
What is a referral?
A recommendation or authorization from one healthcare provider for a patient to receive care from another provider, often a specialist.
A patient needs to see a specialist, but their HMO requires a referral. Who would they generally see first?
Their primary care provider.
What is an out-of-pocket maximum?
It is the most a person generally has to pay for covered, in network services during a plan year.
What is CHIP?
The Children's Health Insurance Program.
What is fee-for-service healthcare?
A payment system in which healthcare providers are paid for individual services they provide.
What is preventive care?
Healthcare intended to prevent illness or detect health problems early.
Why is it important for a patient to understand their insurance plan before receiving healthcare services?
To understand what is covered and what costs they may have to pay.