Terms Flashcards
Deductible
The amount you pay for covered health care services before your insurance plan starts to pay (https://www.healthcare.gov/glossary)
Medicaid
Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities (https://www.healthcare.gov/glossary)
Medicare
A federal health insurance program for people 65 and older and certain younger people with disabilities (https://www.healthcare.gov/glossary)
Claim
A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered (https://www.healthcare.gov/glossary)
Copayment (Copay)
A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible (https://www.healthcare.gov/glossary)
Health insurance
A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium (https://www.healthcare.gov/glossary)
Health coverage
Legal entitlement to payment or reimbursement for your health care costs, generally under a contract with a health insurance company, a group health plan offered in connection with employment, or a government program like Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) (https://www.healthcare.gov/glossary)
Out-of-pocket costs
Your expenses for medical care that aren’t reimbursed by insurance. Includes deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered (https://www.healthcare.gov/glossary)
Preferred Provider Organization (PPO)
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost (https://www.healthcare.gov/glossary)
Flexible Spending Account (FSA)
An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copayments and deductibles, qualified prescription drugs, insulin, and medical devices (https://www.healthcare.gov/glossary)
Hospice
Services to provide comfort and support for persons in the last stages of a terminal illness and their families (https://www.healthcare.gov/glossary)
Pre-existing condition
A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can’t refuse to cover or charge you more (https://www.healthcare.gov/glossary)
Waiting period
The time that must pass before coverage can become effective for an employee or dependent who is otherwise eligible for coverage under a job-based health plan (https://www.healthcare.gov/glossary)
UCR (Usual, Customary, and Reasonable)
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service (https://www.healthcare.gov/glossary)
TRICARE
A health care program for active-duty and retired uniformed services members and their families (https://www.healthcare.gov/glossary)
Specialist
A physician that focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions (https://www.healthcare.gov/glossary)
Referral
A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), necessary before you can get medical care from anyone except your primary care doctor (https://www.healthcare.gov/glossary)
Out of network
A doctor, hospital or other healthcare provider who is not part of an insurance plan, doctor or hospital network (https://www.healthcare.gov/glossary)
Network
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services (https://www.healthcare.gov/glossary)
