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
Assisted Living Facility
A residential facility providing support and care for individuals who need assistance with daily activities, such as dressing, bathing, and managing medications. Coverage of assisted living varies by Medicaid program and state.
A residential facility providing support and care for individuals who need assistance with daily activities, such as dressing, bathing, and managing medications. Coverage of assisted living varies by Medicaid program and state.
Behavioral Health Services
Healthcare services that focus on treating mental health conditions, emotional disorders, and substance use issues. These services are covered under programs like Medicaid, CHIP, and Medicare.
Healthcare services that focus on treating mental health conditions, emotional disorders, and substance use issues. These services are covered under programs like Medicaid, CHIP, and Medicare.
CHIP (Children’s Health Insurance Program)
A joint federal-state program providing low-cost health insurance for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP covers a wide range of health services including doctor visits, immunizations, and prescription drugs.
A joint federal-state program providing low-cost health insurance for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP covers a wide range of health services including doctor visits, immunizations, and prescription drugs.
Catastrophic Coverage (Medicare Part D)
The phase of Medicare Part D coverage that begins after a beneficiary has spent a specified amount on prescription drugs during the year. During this phase, Medicare covers most prescription drug costs, and the beneficiary pays only a small copayment or coinsurance.
The phase of Medicare Part D coverage that begins after a beneficiary has spent a specified amount on prescription drugs during the year. During this phase, Medicare covers most prescription drug costs, and the beneficiary pays only a small copayment or coinsurance.
Dual Eligibility
Refers to individuals who qualify for both Medicare and Medicaid coverage. Dual-eligible beneficiaries often have their Medicare premiums and out-of-pocket costs covered by Medicaid.
Refers to individuals who qualify for both Medicare and Medicaid coverage. Dual-eligible beneficiaries often have their Medicare premiums and out-of-pocket costs covered by Medicaid.
Dependent Care
Care provided for children or dependent adults who require assistance with daily living. Medicaid may cover home or community-based services for dependent care under certain circumstances.
Care provided for children or dependent adults who require assistance with daily living. Medicaid may cover home or community-based services for dependent care under certain circumstances.
Disability Insurance
Insurance that provides income protection to individuals who are unable to work due to a disability. Medicare beneficiaries under age 65 often qualify due to a long-term disability.
Insurance that provides income protection to individuals who are unable to work due to a disability. Medicare beneficiaries under age 65 often qualify due to a long-term disability.
Essential Health Benefits (EHBs)
A set of 10 categories of healthcare services that all ACA-compliant health plans must cover. These services include emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health services, and more.
A set of 10 categories of healthcare services that all ACA-compliant health plans must cover. These services include emergency care, hospitalization, maternity and newborn care, prescription drugs, mental health services, and more.
Emergency Services
Immediate medical care provided for acute, life-threatening conditions. Medicare, Medicaid, CHIP, and ACA-compliant plans all cover emergency services, often without requiring prior authorization.
Immediate medical care provided for acute, life-threatening conditions. Medicare, Medicaid, CHIP, and ACA-compliant plans all cover emergency services, often without requiring prior authorization.
Exclusions
Services or treatments that are not covered by a health insurance plan. Exclusions vary by plan, and they may include specific treatments, procedures, or prescription drugs that are not considered medically necessary.
Services or treatments that are not covered by a health insurance plan. Exclusions vary by plan, and they may include specific treatments, procedures, or prescription drugs that are not considered medically necessary.
Guaranteed Renewal
A feature of health insurance plans that requires the insurer to renew the policyholder’s coverage at the end of each term, regardless of changes in health status. This is required for ACA-compliant plans and Medicare Supplement (Medigap) plans.
A feature of health insurance plans that requires the insurer to renew the policyholder’s coverage at the end of each term, regardless of changes in health status. This is required for ACA-compliant plans and Medicare Supplement (Medigap) plans.
Kidney Transplant
A surgical procedure to replace a failing kidney with a healthy one from a donor. Individuals with End-Stage Renal Disease (ESRD) are eligible for Medicare, regardless of age, and Medicare covers kidney transplants, dialysis, and related services.
A surgical procedure to replace a failing kidney with a healthy one from a donor. Individuals with End-Stage Renal Disease (ESRD) are eligible for Medicare, regardless of age, and Medicare covers kidney transplants, dialysis, and related services.
Medicaid
A joint federal and state program that provides healthcare coverage to low-income individuals, families, seniors, and people with disabilities. Medicaid covers a wide range of services, including doctor visits, hospital stays, long-term care, and preventive care.
A joint federal and state program that provides healthcare coverage to low-income individuals, families, seniors, and people with disabilities. Medicaid covers a wide range of services, including doctor visits, hospital stays, long-term care, and preventive care.
Medicare
A federal program that provides health insurance to individuals 65 and older, as well as younger people with certain disabilities or End-Stage Renal Disease (ESRD). Medicare has different parts that cover hospital care (Part A), medical services (Part B), and prescription drugs (Part D).
A federal program that provides health insurance to individuals 65 and older, as well as younger people with certain disabilities or End-Stage Renal Disease (ESRD). Medicare has different parts that cover hospital care (Part A), medical services (Part B), and prescription drugs (Part D).
Medicare Advantage (Part C)
A type of health plan offered by private insurance companies that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage plans often include extra benefits, such as vision, dental, and prescription drug coverage.
A type of health plan offered by private insurance companies that contracts with Medicare to provide all Part A and Part B benefits. Medicare Advantage plans often include extra benefits, such as vision, dental, and prescription drug coverage.
Medicare Part A
The hospital insurance component of Medicare, which covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.
The hospital insurance component of Medicare, which covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.
Medicare Part B
The medical insurance component of Medicare that covers outpatient services, doctor visits, preventive services, and some home health care. Part B requires a monthly premium, which is based on income, and there are cost-sharing requirements for services.
The medical insurance component of Medicare that covers outpatient services, doctor visits, preventive services, and some home health care. Part B requires a monthly premium, which is based on income, and there are cost-sharing requirements for services.
Medicare Part D
The prescription drug coverage component of Medicare, available through private plans. Part D helps beneficiaries pay for the cost of prescription medications, with cost-sharing determined by drug formularies and tier levels.
The prescription drug coverage component of Medicare, available through private plans. Part D helps beneficiaries pay for the cost of prescription medications, with cost-sharing determined by drug formularies and tier levels.
Medicare Supplement Insurance (Medigap)
Private health insurance that helps cover the out-of-pocket costs associated with Original Medicare (Parts A and B), such as copayments, coinsurance, and deductibles. Medigap plans are standardized and regulated by federal and state laws.
Private health insurance that helps cover the out-of-pocket costs associated with Original Medicare (Parts A and B), such as copayments, coinsurance, and deductibles. Medigap plans are standardized and regulated by federal and state laws.