Finace health care Flashcards
(23 cards)
What is Health Insurance?
A plan that helps pay for medical care.
Health insurance can cover various medical services, including hospital stays, doctor visits, and preventive care.
Define Premium in the context of health insurance.
The amount you pay every month for your insurance.
Premiums are typically paid regardless of whether you use medical services.
What is a Deductible?
The amount you pay out of pocket before insurance starts helping.
After meeting the deductible, the insurance begins to cover its share of costs.
What does Copayment (Copay) refer to?
A set fee you pay for a doctor visit or medicine.
Copays can vary depending on the type of service received.
Explain Coinsurance.
A percentage you pay for care after your deductible is met.
For example, if your coinsurance is 20%, you pay 20% of the costs while the insurance pays 80%.
What is the Out-of-Pocket Maximum?
The most you’ll pay in a year for covered care; after that, insurance pays everything.
This limit protects you from high medical costs.
What is COBRA?
A law that lets you keep your job’s health insurance for a while after you leave your job (you pay full price).
COBRA coverage can last for up to 18 months in most cases.
Define HMO.
A type of plan where you must use doctors in the plan’s network and need a referral to see specialists.
HMOs often have lower premiums and out-of-pocket costs.
What does PPO stand for?
Preferred Provider Organization.
PPO plans offer more flexibility in choosing healthcare providers.
What is Medicare?
Government health insurance for people 65 and older or with certain disabilities.
Medicare has different parts covering hospital care, medical services, and prescription drugs.
What is Medicaid?
Government health insurance for people with low income.
Eligibility and benefits can vary by state.
What is Medi-Cal?
California’s version of Medicaid.
Medi-Cal provides health coverage for low-income individuals and families in California.
What is the Marketplace (Health Insurance Exchange)?
A website where you can compare and buy health insurance.
The Marketplace was created under the Affordable Care Act.
What is Employer-Sponsored Insurance?
Health insurance you get through your job.
Often, employers subsidize part of the premium costs.
What is the Affordable Care Act (ACA)?
A law that made health insurance easier to get and required some coverage rules.
The ACA aims to expand access to health insurance and reduce healthcare costs.
Define Flexible Spending Account (FSA).
An account you put money in (before taxes) to use for medical costs.
FSAs can be used for a variety of out-of-pocket health expenses.
What is a Health Savings Account (HSA)?
A savings account for medical costs that works with high-deductible plans and has tax benefits.
Contributions to HSAs are tax-deductible, and withdrawals for qualified medical expenses are tax-free.
What is a Network in insurance?
A group of doctors and hospitals that work with your insurance plan.
Staying within the network typically results in lower costs.
Define In-Network Provider.
A doctor or hospital that works with your insurance and costs less to see.
Using in-network providers can significantly reduce out-of-pocket expenses.
What is an Out-of-Network Provider?
A doctor or hospital not in your insurance plan; usually costs more.
Out-of-network services may have higher deductibles and coinsurance rates.
What is a Claim?
A request sent to insurance asking for payment for medical care.
Claims can be for various services, including treatments and procedures.
Who is a Primary Care Provider?
Your main doctor who handles general health needs.
PCPs often coordinate care and refer patients to specialists.
What is a Referral?
A written order from your doctor to see a specialist.
Referrals are commonly required by HMO plans.
