Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
Coinsurance
The percentage of medical costs a patient must pay after meeting their deductible. For example, a Medicare plan might require patients to pay 20% of the cost of services after Medicare has paid its share.
The percentage of medical costs a patient must pay after meeting their deductible. For example, a Medicare plan might require patients to pay 20% of the cost of services after Medicare has paid its share.
Copayment (Copay)
A fixed amount an individual pays for a covered healthcare service, such as a doctor visit or prescription, after meeting their deductible. The amount varies by service and insurance plan.
A fixed amount an individual pays for a covered healthcare service, such as a doctor visit or prescription, after meeting their deductible. The amount varies by service and insurance plan.
Deductible
The amount an individual must pay out-of-pocket for covered healthcare services before their insurance plan starts to cover costs. Deductibles apply to various types of insurance, including Medicare, Medicaid, ACA, and CHIP plans.
The amount an individual must pay out-of-pocket for covered healthcare services before their insurance plan starts to cover costs. Deductibles apply to various types of insurance, including Medicare, Medicaid, ACA, and CHIP plans.
Flexible Spending Account (FSA)
A tax-advantaged account that allows individuals to set aside pre-tax dollars to pay for eligible healthcare expenses, such as medical, dental, and vision care. FSAs are commonly offered by employers as part of health benefit plans, and the funds must be used within a specified period.
A tax-advantaged account that allows individuals to set aside pre-tax dollars to pay for eligible healthcare expenses, such as medical, dental, and vision care. FSAs are commonly offered by employers as part of health benefit plans, and the funds must be used within a specified period.
Health Savings Account (HSA)
A tax-advantaged account used to save and pay for qualified medical expenses. HSAs are available to individuals enrolled in high-deductible health plans (HDHPs) and offer tax-free contributions, growth, and withdrawals for healthcare costs.
A tax-advantaged account used to save and pay for qualified medical expenses. HSAs are available to individuals enrolled in high-deductible health plans (HDHPs) and offer tax-free contributions, growth, and withdrawals for healthcare costs.
Health Reimbursement Arrangement (HRA)
An employer-funded arrangement that reimburses employees for qualified medical expenses. Unlike an HSA, only the employer can contribute to an HRA, and the funds can be used for various healthcare costs, such as copayments and deductibles.
An employer-funded arrangement that reimburses employees for qualified medical expenses. Unlike an HSA, only the employer can contribute to an HRA, and the funds can be used for various healthcare costs, such as copayments and deductibles.
Out-of-Pocket Costs
Medical expenses that are not covered by insurance, such as copayments, deductibles, and coinsurance, which must be paid directly by the individual. Out-of-pocket costs apply to Medicare, Medicaid, CHIP, and ACA plans.
Medical expenses that are not covered by insurance, such as copayments, deductibles, and coinsurance, which must be paid directly by the individual. Out-of-pocket costs apply to Medicare, Medicaid, CHIP, and ACA plans.
Out-of-Pocket Maximum
The maximum amount an individual must pay for covered healthcare services in a plan year before the insurance company covers 100% of the costs. Out-of-pocket maximums apply to ACA Marketplace plans, Medicare Advantage, and some Medicaid programs.
The maximum amount an individual must pay for covered healthcare services in a plan year before the insurance company covers 100% of the costs. Out-of-pocket maximums apply to ACA Marketplace plans, Medicare Advantage, and some Medicaid programs.
Yearly Out-of-Pocket Maximum
The maximum amount an individual must pay for covered services in a calendar year before their health insurance plan covers 100% of additional costs. This applies to ACA Marketplace, Medicare Advantage, and some Medicaid plans. Once the yearly out-of-pocket maximum is reached, the insurer pays all remaining covered expenses.
The maximum amount an individual must pay for covered services in a calendar year before their health insurance plan covers 100% of additional costs. This applies to ACA Marketplace, Medicare Advantage, and some Medicaid plans. Once the yearly out-of-pocket maximum is reached, the insurer pays all remaining covered expenses.