Healthcare Glossary

NEED HELP IN UNDERSTANDING YOUR HEALTH INSURANCE ?

Unsure of some of the terms used in your policy or reports? You will be happy to know that the Health Issues committee of our LWVPBC has composed a glossary of health insurance terms to assist you.

 

HEALTHCARE GLOSSARY

AHCA – American Health Care Association (a non-profit federation of affiliated state health organizations).

AHCA – American Health Care Act (aka as Trumpcare) (Note: Senate version is pending as of 6/26/17.).

ACA – Affordable Care Act (aka Obamacare)

AAAHC – Accreditation Association for Ambulatory Health Care

Capitation – a payment arrangement for healthcare service providers (physicians, etc.). It pays a set amount for each enrolled person, per period of time, whether or not they seek care.

Catastrophic Health Plan – one that provides minimal coverage

CHAIN – Community Health Action Information Network (A statewide consumer health advocacy organization)

CHIP – Children’s Health Insurance Program

CTG – Close the Gap (a statewide attempt to expand Medicaid coverage to the working poor)

CMS – Children’s Medical Services (Note – CMS can also stand for the Federal Center for Medicare and Medicaid Service)

COBRA – Consolidated Omnibus Budget Reconciliation Act (a federal law that allows you to temporarily keep health coverage after your employment ends, but you must pay for it).

Co-insurance: Joint assumption of risk (as by 2 underwriters). (For example-this frequently involves a percentage assignment for responsibility, i.e., 80/20 whereby insurer pays 80% and beneficiary pays 20% of remaining allowable amount).

Co-pay: amount that a person with health insurance is required to pay out of pocket at each visit or for each purchase, in addition to what their insurance will cover for it.

Coverage Gap – uninsured poor adults in states that do not expand Medicaid

Deductible – the amount of money the insured person pays out of pocket for most covered medical expenses, before their insurance plan begins to pay for those covered expenses.

DME – Durable Medical Equipment

DSH – Disproportionate Share Hospital

FPL – Federal Poverty Level (used to determine eligibility for Medicaid and CHIP) Example-$11,880 for individuals and $16,020 for a family of 2.

FHA – Florida Health Alliance

FHIX – Florida Health Insurance Affordability Exchange Program (State Senate Bill 7044)-did not pass

FQHC – Federally Qualified Health Center (49 in FL, with 426 clinics)

GME – Graduate Medical Education

GP – General Practioner

HCFA – HealthCare Financing Administration (replaced by Federal CMS)

HHS – Health and Human Services (Federal program)

HIPAA – Health Insurance Portability and Accountability Act (protects patients’ privacy)

HMO – Health Maintenance Organization (a medical insurance group that provides healthcare for a fixed annual fee). (Examples – Cigna, Kaiser Permanente, Humana, etc.)

Insurance – coverage by contract where company indemnifies an individual against loss or illness

LIP – Low Income Pool (Federal funds for healthcare assistance to hospitals)

MCO’s – Managed Care Organizations

Medicaid – a joint federal and state program that helps with medical costs for some people with limited income.

Medicaid Expansion – would allow people with annual income below 138% of federal poverty level to be eligible for Medicaid.

Medicaid Managed Care Program – a system of providing Medicaid services using MCO’s.

Medicare – National Social Insurance Program, mostly for people aged 65 and over.

Medicare Advantage Plans – a program within Part C of Medicare. They provide a managed healthcare plan (typically an HMO) but they also offer some PPO’s. This is an alternative to Original Medicare Parts A & B. They have advantage (e.g., low or no premiums and low or no co-pays) but also have disadvantages (e.g. if hospitalization is required).

Medicare Part A – hospital coverage

Medicare Part B – the bulk of healthcare, received as an outpatient (includes doctor’s visits, laboratory, etc.).

Medicare Part C – aka as Medicare Advantage plans. It is an alternative to standard Medicare. (You can choose Part C, OR regular Medicare, which is Part A & B.)

Medicare Part D – Prescription Drug Coverage

Medigap plans – Supplemental health insurance plans.

Millenials – students and young workers aged 18-32, who can particularly benefit from strengthening Medicaid

PCP – Primary Care Physician

PPO – Preferred Provider Organization (a managed care organization of doctors, hospitals, etc. who have reached an agreement with third party (insurers) to provided healthcare at reduced rates.

Pre-existing condition: a health problem that you had before the date that new health coverage starts. (Note – under current law, as of April, 2017 insurance companies cannot deny coverage or punish someone with a pre-existing condition.)

Premium – usually refers to the monthly cost to the beneficiary, once they purchase a plan.

Preventive screenings – similar to “wellness checks”

RAM – Remote Area Medical (a volunteer medical relief corps)

Safety Net Hospitals – hospitals and clinics that provide a significant level of care to low-income, uninsured, and vulnerable populations. (Examples: Jackson Memorial, Broward Health, H. Lee Moffitt, etc.)

SCHIP – State Children’s Health Insurance Program

Single payer – refers to healthcare financed by a single public body from a single fund, rather than individuals buying from private insurers. (Canada has this type of healthcare system.) (Note: Hybrid single-payer, e.g. in UK, consists of a number of autonomous trusts and private health insurance options are allowed.) (Note-this is sometimes referred to as “Medicare for All”.)

SNIF – Skilled Nursing Facility

SSA – Social Security Act (Medicare was enacted under this)

“State- based solutions” – refers to support of local bills as opposed to Federal mandates

Supplemental Insurance – extra insurance that you can purchase to help you pay for deductibles, co-pays, etc.

Tricare– healthcare program for military personnel (Note – it replaced CHAMPUS.)

Universal Healthcare – aka “socialized medicine”, “single-payor”, etc.

VIP Health Insurance – aka Concierge Medical Practice. The PCP sees a fixed number of patients, who pay an annual fixed fee. They usually do not bill insurance.

WHO – World Health Organization

REFERENCES:

www.healthcare.gov

2015-2016 Close The Gap Messaging Guide (from FHA)

www.ACHA.myflorida.com

-www.cms.gov/resources/glossary