Health insurance basics
This is the amount you pay every month to keep your health insurance active.
What is a premium?
This common plan type usually requires choosing a primary care doctor and getting referrals to see specialists.
What is an HMO (Health Maintenance Organization)?
This joint federal and state program provides health coverage for people with low income.
What is Medicaid?
These are routine visits to a doctor to stay healthy and detect problems early.
What is preventive care?
This document explains what medical services your insurance plan will pay for.
What is a policy?
This is the amount you must pay out of pocket before insurance starts paying for services.
What is a deductible?
This plan type allows more flexibility to see specialists without referrals but often costs more.
What is a PPO (Preferred Provider Organization)?
This program provides health insurance for children in families who earn too much for Medicaid but still need assistance.
What is CHIP (Children’s Health Insurance Program)?
This type of care is received when a medical condition requires immediate attention.
What is emergency care?
This is the request sent to an insurance company asking them to pay for medical services.
What is a claim?
This is a fixed amount you pay for a doctor visit or prescription.
What is a copay?
This type of plan combines features of HMOs and PPOs and may require referrals.
What is a POS (Point of Service plan)?
This part of Medicare covers hospital stays and inpatient care.
What is Medicare Part A?
This refers to prescription medications that are covered by your insurance plan.
What are covered drugs or a formulary?
This document shows how much the insurance company paid and what you still owe.
What is an Explanation of Benefits (EOB)?
This term describes the percentage of costs you pay after meeting your deductible.
What is coinsurance?
This high-deductible plan is often paired with a tax-advantaged savings account for medical expenses.
What is a High Deductible Health Plan (HDHP)?
This part of Medicare covers doctor visits and outpatient services.
What is Medicare Part B?
This term describes doctors or hospitals that have contracts with your insurance company.
What are in-network providers?
This process allows a patient to challenge a denied insurance claim.
What is an appeal?
This is the maximum amount you pay in a year before insurance covers 100% of covered services.
What is the out-of-pocket maximum?
This government program provides health insurance mainly for people age 65 and older.
What is Medicare
This law, passed in 2010, expanded health insurance coverage and created healthcare marketplaces.
What is the Affordable Care Act (ACA)?
Care received from providers who do not have agreements with your insurance company is called this.
What is out-of-network care?
This approval from the insurance company may be required before certain treatments or procedures.
What is prior authorization?